Clinical Study On The Effects Of Laparoscopic Core Pulling Method To Remove The Tubal Of Tubal Pregnancy On Ovarian Function

Objective: By detecting the changes of serum hormone levels and transvaginal color Doppler ultrasound indexes after two kinds of surgical operations,which are laparoscopic traditional salpingectomy and laparoscopic core pulling method salpingectomy in patients with tubal pregnancy,to explore the impact of laparoscopic core pulling method salpingectomy on ovarian function,and provide a basis for clinical application.Methods: Selected the patients who were initially diagnosed as ectopic pregnancy in the gynecological outpatient department of our hospital from August 2018 to October 2019,and screening of patients with surgical indications after hospitalization.After the informed consent of the ethics committee and the approval of the research scheme,the patients who meet the inclusion criteria were taken as the research objects,then informed them the detailed content of this study and signed the relevant informed consent with them.The patients were randomly divided into two groups:Laparoscopic core pulling method salpingectomy group(group A,n = 31 cases)and laparoscopic traditional salpingectomy group(group B,n = 32 cases).All patients returned to the hospital on the 2nd-5th day of menstruation during the first month,the third month,the sixth month respectively after surgery,for fasting detect serum FSH(Follicle-Stimulating Hormone),LH(Luteinizing Hormone),E2(Estradiol)and AMH(Anti-Mullerian Hormone)values,and during the first month,the third month,and the sixth month after surgery,return to the hospital within 3-5 days after menstruation is clean.Transvaginal color Doppler ultrasound is used to detect PSV(Peak systolic velocity)and RI(Resistance index)of the affected ovarian interstitial artery.Use Epidata to preliminarily organize all data.A total of 63 patients met the inclusion criteria,during the follow-up,3 patients were lost to follow-up.Among them,2 cases were laparoscopic traditional salpingectomy and 1 case was laparoscopic core pulling method salpingectomy.Finally,the number of cases completed by each groups was 30 cases.SPSS20.0 statistical software was used for statistical analysis of this research.The measurement data were expressed as mean±standard deviation(sx ±).The t-test was used to compare the general clinical data of the two groups of patients;the comparison of serological parameters and transvaginal Doppler ultrasound parameters,using the F test of repeated measurement design,taking P?0.05 as the difference is statistically significant,to evaluate the effect of different surgical methods on ovarian function.Results: 1.There was no statistically significant difference in the general clinical data such as age,surgery operation time,intraoperative blood loss,and hospitalization time between the two groups(P > 0.05).2.The serological indexes of the two groups:(1)the FSH values of group A were lower than those of group B at the same time point,and P<0.05 of the follow-up at the first month,third month and sixth month after the surgery between the two groups,indicating that there was statistical significance in the difference of FSH indexes of different operation methods,and there was no statistical significance between different time points and groups with the time point interaction(P > 0.05),indicating that the FSH value of patients after salpingectomy has little change with time during the observation period.(2)AMH showed a downward trend,the AMH values of group A were higher than those of group B at the same time point,and the differences were statistically significant at different time points and between groups,indicating that the AMH of the two groups decreased significantly in the research period,and group B decreased more significantly than that of group A,and the interaction between groups and time point had no statistical significance.(3)E2 and LH fluctuated slowly or irregularly with time,there was no statistically significant difference between different time points,the interaction between groups and time points,and the difference between the two surgical groups(P > 0.05).3.The Doppler ultrasound indexes of the affected ovaries in the two groups of patients: PSV,RI,the difference between the two surgical groups was statistically significant(P<0.05),and the PSV values of the patients in group A were higher than those in group B at the same time point,RI values are lower than Group B.There was no statistically significant difference in the interaction between different time points,groups and time points(P>0.05),indicating that the PSV and RI of the two groups ofpatients after the salpingectomy fluctuated slowly or irregularly with time.Conclusion: 1.Compared with traditional laparoscopic salpingectomy,laparoscopic salpingectomy has less damage to ovarian reserve function;2.AMH has advantages in predicting changes in ovarian reserve function after tubal pregnancy surgery.