Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, 36 San Hao Street, Heping District, Liaoning, 110004, Shenyang, China.
J Ovarian Res. 2021 Jun 29;14(1):86. doi: 10.1186/s13048-021-00825-w.
Bilateral salpingectomy has been proposed to reduce the risk of ovarian cancer, but it is not clear whether the surgery affects ovarian reserve. This study compares the impact of laparoscopic hysterectomy for benign disease with or without prophylactic bilateral salpingectomy on ovarian reserve.
Records were reviewed for 373 premenopausal women who underwent laparoscopic hysterectomy with ovarian reserve for benign uterine diseases. The serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and three-dimensional antral follicle count (AFC) were assessed before surgery and 3 and 9 months postoperatively to evaluate ovarian reserve. Patients were divided into two groups according to whether they underwent prophylactic bilateral salpingectomy. The incidence of pelvic diseases was monitored until the ninth month after surgery.
There was no significant difference between the two surgery groups in terms of baseline AMH, E2, FSH, LH, and AFC (all P > 0.05). There was no difference in potential bias factors, including patient age, operative time, and blood loss (all P > 0.05). There was also no significant difference between the two groups 3 months after surgery with respect to AMH (P = 0.763), E2 (P = 0.264), FSH (P = 0.478), LH (P = 0.07), and AFC (P = 0.061). Similarly, there were no differences between groups 9 months after surgery for AMH (P = 0.939), E2 (P = 0.137), FSH (P = 0.276), LH (P = 0.07) and AFC (P = 0.066). At 9 months after the operation, no patients had malignant ovarian tumors. The incidences of benign ovarian tumors in the salpingectomy group were 0 and 2.68 % at 3 and 9 months after surgery, respectively, and the corresponding values in the control group were 0 and 5.36 %. The incidences of pelvic inflammatory disease in the salpingectomy group were 10.72 and 8.04 % at 3 and 9 months after surgery, respectively, while corresponding values in the control group were 24.13 and 16.09 %.
Prophylactic bilateral salpingectomy did not damage the ovarian reserve of reproductive-age women who underwent laparoscopic hysterectomy. Prophylactic bilateral salpingectomy might be a good method to prevent the development of ovarian cancer. Larger clinical trials with longer follow-up times are needed to further evaluate the risks and benefits.
双侧输卵管切除术已被提议用于降低卵巢癌的风险，但目前尚不清楚该手术是否会影响卵巢储备功能。本研究比较了腹腔镜子宫切除术治疗良性疾病时是否行预防性双侧输卵管切除术对卵巢储备的影响。
回顾性分析了 373 例因良性子宫疾病行腹腔镜子宫切除术且保留卵巢储备功能的绝经前妇女的病历资料。在术前及术后 3 个月和 9 个月，评估血清抗苗勒管激素（AMH）、卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）和三维窦卵泡计数（AFC），以评估卵巢储备功能。根据是否行预防性双侧输卵管切除术，将患者分为两组。术后 9 个月监测盆腔疾病的发生情况。
两组患者在基线 AMH、E2、FSH、LH 和 AFC 方面无显著差异（均 P＞0.05）。患者年龄、手术时间和出血量等潜在偏倚因素无差异（均 P＞0.05）。术后 3 个月，两组间 AMH（P＝0.763）、E2（P＝0.264）、FSH（P＝0.478）、LH（P＝0.07）和 AFC（P＝0.061）差异均无统计学意义。术后 9 个月，两组间 AMH（P＝0.939）、E2（P＝0.137）、FSH（P＝0.276）、LH（P＝0.07）和 AFC（P＝0.066）差异均无统计学意义。术后 9 个月时，无患者发生卵巢恶性肿瘤。输卵管切除术组术后 3 个月和 9 个月的良性卵巢肿瘤发生率分别为 0 和 2.68％，对照组分别为 0 和 5.36％。输卵管切除术组术后 3 个月和 9 个月的盆腔炎发生率分别为 10.72％和 8.04％，对照组分别为 24.13％和 16.09％。
对于行腹腔镜子宫切除术的生育期妇女，预防性双侧输卵管切除术不会损害其卵巢储备功能。预防性双侧输卵管切除术可能是预防卵巢癌发生的一种较好方法。需要更大规模的临床试验和更长时间的随访来进一步评估其风险和获益。
