AMH在妇科腹腔镜手术前后卵巢功能中的评估价值

doi:10.3969/j.issn.1671-7171.2018.01.003

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摘要【目的】探讨抗苗勒管激素(anti-mullerian hormone,AMH)在妇科腹腔镜手术前后卵巢功能中的评估价值。【方法】选择2016年1月至2016年12月本院妇产科诊治的妇科疾病患者370例,其中卵巢组80例,子宫肌瘤组90例,输卵管组200例。比较各种术式患者术前、术后6周及术后6个月的 AMH水平。【结果】卵巢巧克力囊肿患者、非巧克力囊肿患者术后6周及6个月血清AMH水平较术前均显著下降(P<0.05),且术后6个月血清AMH水平显著低于术后6周(P<0.05),但卵巢巧克力囊肿患者AMH水平比非巧克力囊肿患者下降更为显著(P<0.05)。次全子宫切除术患者、子宫肌瘤剔除术患者术前血清AMH比较差异均无统计学意义 (P>0.05);两组术后6周、6个月的血清AMH水平较术前降低(P<0.05),且两组术后6个月血清AMH水平均显著低于术后6周(P<0.05),次全子宫切除术患者血清AMH水平低于同期子宫肌瘤剔除术患者。单侧输卵管切除组和单侧输卵管切除+对侧输卵管结扎组术前血清AMH水平比较差异无统计学意义(P>0.05 );单侧输卵管切除组术后6个月血清AMH水平均显著低于术前(P<0.05); 单侧输卵管切除组和单侧输卵管切除+对侧输卵管结扎组术前后各时点血清AMH水平比较差异无统计学意义(P>0.05 )。【结论】术后6个月,腹腔镜下卵巢囊肿剥除术对卵巢储备功能有不利影响;且巧克力卵巢囊肿较非巧克力卵巢囊肿,术后卵巢储备下降更明显;腹腔镜下次全子宫切除术对卵巢储备有不利影响,子宫肌瘤剔除术影响不大。腹腔镜下单侧输卵管切除组和单侧输卵管切除+对侧输卵管结扎组对卵巢储备功能均有不利影响,需要根据患者病情和要求采取合适的手术方式。

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	杨智红
	陈光元
	谢家滨
	张红丽

关键词 ：抗苗勒管激素, 腹腔镜检查, 妇科外科手术, 卵巢功能试验

Abstract：【Objective】To evaluate the value of anti-mullerian hormone (AMH) in the evaluation of ovarian function before and after laparoscopic gynecologic surgery.【Methods】From January 2016 to December 2016, 370 cases of gynecological diseases diagnosed and treated in gynecology and obstetrics department in our hospital were selected.There were 80 cases in ovary group, 90 cases in hysteromyoma group and 200 cases in fallopian tube group. The levels of AMH were compared at the time before operation, 6 weeks and 6 months after operation.【Results】The serum AMH levels in patients with ovarian chocolate cysts and those with non-chocolate cysts at 6 weeks and 6 months after operation were significantly lower than those before operation (P<0.05). The level of serum AMH 6 of months after operation was significantly lower than that of 6 weeks after the operation (P<0.05).However, the level of AMH in patients with ovarian chocolate cysts was significantly lower than that in patients with non-chocolate cysts (P<0.05). There was no significant difference in serum AMH between subtotal hysterectomy patients and hysteromyomectomy patients (P>0.05). 6 weeks and 6 months after operation, the serum AMH level in both groups was significantly lower than that before operation (P<0.05), and the level of serum AMH at 6 months after operation in both groups was significantly lower than that at 6 weeks after operation (P<0.05). The serum AMH level of subtotal hysterectomy patients was lower than that of hysteromyomectomy patients in the same period. There was no significant difference in serum AMH level between the unilateral salpingotomy group and the unilateral salpingotomy group + the contralateral salpingotomy group (P>0.05). The serum AMH level in unilateral salpingotomy group at months after operation was significantly lower than that of preoperation (P<0.05). There was no significant difference in serum AMH levels between the unilateral salpingotomy group and the unilateral salpingotomy group + the contralateral salpingotomy group (P>0.05).【Conclusion】Six months after operation, laparoscopic excision of ovarian cysts had adverse effects on ovarian reserve function, and the ovarian reserve of chocolate ovarian cysts decreased more obviously than that of non-chocolate ovarian cysts. Laparoscopic subtotal hysterectomy has a negative effect on ovarian reserve, while uterine myomectomy has little effect. The unilateral salpingotomy group and the unilateral salpingotomy group + the contralateral salpingotomy group under laparoscopy have adverse effects on ovarian reserve function.Appropriate surgical methods should be adopted according to the patient's condition and requirement.

Key words： Anti-Mullerian Hormone Laparoscopy Gynecologic Surgical Procedures Ovarian Function Tests

收稿日期: 2017-11-27

PACS:

R339.221

基金资助:2016年深圳市宝安区医疗卫生科研项目(编号:2016CX095)

引用本文:

杨智红,陈光元,谢家滨,张红丽. AMH在妇科腹腔镜手术前后卵巢功能中的评估价值[J]. 医学临床研究, 2018, 35(1): 8-10,14.
YANG Zhi-hong,CHEN Guang-yuan,XIE Jia-bin,et al. Evaluation of AMH in Ovarian Function Before and After Laparoscopic Gynecological Surgery. JOURNAL OF CLINICAL RESEARCH, 2018, 35(1): 8-10,14.

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http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2018.01.003 或 http://www.jcr.net.cn/CN/Y2018/V35/I1/8

[1] 陈薪,尹敏娜,叶德盛,等.血清与卵泡液抗苗勒氏管激素对多囊卵巢综合症患者体外受精-胚胎移植临床结果的预测价值[J].南方医科大学学报,2013,33(4):546-549.
[2] 陈晓,季银芬,徐键,等.抗苗勒氏管激素(AMH)与多囊卵巢综合征(PCOS)卵泡发育异常的关系[J].生殖与避孕,2014,34(5):383-387,400.
[3] 苍荣,夏天,王宝娟,等.抗苗勒氏管激素的研究新进展及对IVF-ET的意义[J].实用医学杂志,2011,27(18):3428-3430.
[4] Kuroda K,Uchida T,Nagai S,et al.Elevated serum thyroid-stimulating hormone is associated with decreased anti-Mullerian hormone in infertile women of reproductive age[J].J Assist Reprod Genet,2015,32(2):243-247.
[5] 袁华,赵绍杰,王家俊,等.血清抗苗勒氏管激素评价腹腔镜下卵巢囊肿剥除术对卵巢储备功能影响的临床研究[J].中国妇幼保健,2014,29(35):5868-5870.
[6] 王飞苗,罗艳,马会明,等.多囊卵巢综合征患者抗苗勒氏管激素与干细胞因子的相关性[J].西安交通大学学报(医学版),2012,33(4):482-485.
[7] 王海英,梁洁玲,毕燕玲,等.抗苗勒氏管激素检测对子宫切除术后患者卵巢功能的评价[J].吉林大学学报(医学版),2014,25(4):875-879.
[8] Li Y,Nie M,Liu Y,et al.The dynamic changes of anti-Mullerian hormone and inhibin B during controlled ovarian hyperstimulation in decreased ovarian reserve women and the effect on clinical outcome[J].Gynecol Endocrinol,2015,31(6):450-453.
[9] 李建新.抗苗勒氏管激素在PCOS、POF、正常人群之间的差异[J].中国妇幼保健,2013,28(6):940-941.
[10] 徐燕颖.多囊卵巢综合征患者抗苗勒氏管激素与相关临床指标的关系[J].天津医药,2013,41(2):119-121.
[11] Dunlop CE,Anderson RA.Uses of anti-Mullerian hormone (AMH) measurement before and after cancer treatment in women[J].Maturitas,2015,80(3):245-250.
[12] 张迪,桑丽英,崔蓉,等.体外颗粒细胞培养中抗苗勒管激素与卵泡刺激素受体mRNA表达的相关性[J].广东医学,2012,33(7):883-886.
[13] 杨硕,尤昭玲,孙晓峰,等.抗苗勒氏管激素与多囊卵巢综合征卵泡发育相关性的研究进展[J].湖南中医药大学学报,2015,35(9):65-69.
[14] 刘磊,芦小单,林秀英,等.AMHR2在人子宫内膜组织中的表达及相关研究[J].中国实验诊断学,2016,20(11):1856-1858.
[15] 邵一丹,梁元姣,陈莉,等.抗苗勒氏管激素下降率对多囊卵巢患者促排卵疗效的预测价值[J].医学研究生学报,2016,29(6):616-620.
[16] 董莉,张保平,冯新平,等.血清雄性激素、AM H检测在女性不孕诊断中的应用价值[J].现代检验医学杂志,2016,31(3):77-80.
[17] Codner E,Iniguez G,Hernandez IM,et al.Elevated anti-Mullerian hormone (AMH) and inhibin B levels in prepubertal girls with type 1 diabetes mellitus [J] .Clin Endocrinol (Oxf),2011,74(1):73-78.