Rodgers Rachael, Carter Jonathan, Reid Geoffrey, Krishnan Surya, Ludlow Joanne, Cooper Michael, Abbott Jason
Department of Reproductive Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.
School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2020 Apr;60(2):278-283. doi: 10.1111/ajo.13129. Epub 2020 Feb 17.
Salpingectomy may damage ovarian reserve by direct vascular interruption to the ovary or thermal vascular injury from electrosurgery. It is plausible that this risk may increase in the context of salpingectomy conducted for ectopic pregnancy due to the distension of the fallopian tube and vascular changes associated with pregnancy.
To report anti-Müllerian hormone (AMH) concentrations before and after laparoscopic salpingectomy for ectopic pregnancy as an indicator of change in ovarian reserve.
Women aged 18-44 years scheduled for salpingectomy for tubal ectopic pregnancy were prospectively recruited. Serum AMH concentrations were measured immediately prior to surgery, then repeated four months post-operatively. In all cases, salpingectomy was conducted laparoscopically using bipolar electrosurgery and mechanical scissors. A group of women scheduled for uterine curettage for first trimester miscarriage was recruited to ensure any observed change in AMH concentration in the women undergoing salpingectomy was secondary to surgery, rather than an effect of pregnancy.
Paired pre- and post-operative serum AMH concentrations were obtained from 32 women with tubal ectopic pregnancy. The mean age of the women was 33.6 ± 4.6 years. There was no significant difference in the median pre- and post-operative AMH concentrations (13.00 pmol/L (range 5-67 pmol/L) vs 15.25 pmol/L (range 3-96 pmol/L), P = 0.575). Median AMH concentrations also remained stable in women experiencing a first trimester miscarriage (10.40 pmol/L (range 3.9-37.8 pmol/L) vs 13.67 pmol/L (range 2.8-30.5 pmol/L), P = 0.185).
Laparoscopic salpingectomy using electrosurgery and mechanical scissors does not damage ovarian reserve. AMH concentrations do not fluctuate from baseline in the first trimester of pregnancy.
输卵管切除术可能通过直接中断卵巢血管或电外科手术造成的热血管损伤来损害卵巢储备功能。由于输卵管扩张以及与妊娠相关的血管变化，在因异位妊娠进行输卵管切除术的情况下，这种风险可能会增加。
报告异位妊娠腹腔镜输卵管切除术前、后的抗苗勒管激素（AMH）浓度，以此作为卵巢储备功能变化的指标。
前瞻性招募计划因输卵管异位妊娠接受输卵管切除术的18 - 44岁女性。在手术前即刻测量血清AMH浓度，术后4个月重复测量。所有病例均采用双极电外科手术和机械剪刀进行腹腔镜输卵管切除术。招募一组计划因孕早期流产进行刮宫术的女性，以确保输卵管切除术后女性AMH浓度的任何观察到的变化是手术所致，而非妊娠的影响。
从32例输卵管异位妊娠女性中获得了配对的术前和术后血清AMH浓度。这些女性的平均年龄为33.6 ± 4.6岁。术前和术后AMH浓度中位数无显著差异（13.00 pmol/L（范围5 - 67 pmol/L）对15.25 pmol/L（范围3 - 96 pmol/L），P = 0.575）。孕早期流产女性的AMH浓度中位数也保持稳定（10.40 pmol/L（范围3.9 - 37.8 pmol/L）对13.67 pmol/L（范围2.8 - 30.5 pmol/L），P = 0.185）。
使用电外科手术和机械剪刀进行的腹腔镜输卵管切除术不会损害卵巢储备功能。妊娠早期AMH浓度不会偏离基线波动。
