Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: Primum non nocere
Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: Primum non nocere
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DOI：
10.1016/j.ygyno.2013.03.023
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发表时间：
2013-06-01
影响因子：
4.7
通讯作者：
Zullo, Fulvio
中科院分区：
文献类型：
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作者：
Morelli, Michele;Venturella, Roberta;Zullo, Fulvio
目标。本研究的目的是比较良性子宫病变患者行腹腔镜全子宫切除术（TLH）加输卵管切除术与行标准TLH并保留附件的患者的卵巢功能和手术结果。我们回顾性比较了79例行TLH +双侧输卵管切除术（A组）和79例行标准TLH +附件切除术（sTLH）的女性（B组）的数据。记录每位患者术后3个月抗苗勒管激素（AMH）、促卵泡激素（FSH）、窦卵泡计数（AFC）、平均卵巢直径和峰值收缩速度（PSV）值与术前的差值。每次手术、手术时间、血红蛋白水平变化（δ Hb）、术后住院时间、术后恢复正常活动、并记录并发症发生率作为次要转归。根据我们的事后分析，该等效性研究的统计效力为96.8%。Delta AMH （p = 0.35）、Delta FSH （p = 0.15）、Delta AFC （p = 0.09）、A平均卵巢直径（p = 0.57）和Delta PSV （p = 0.61）组间差异无统计学意义。此外，手术时间（p = 0.79）、Delta Hb （p = 0.41）、术后住院时间（p = 0.16）、术后恢复正常活动（p = 0.11）、并发症发生率等次要指标也无显著差异。不携带BRCA1/2突变的女性在TLH中加入双侧输卵管切除术以预防卵巢癌，对卵巢功能没有负面影响。此外，TLH的围手术期并发症与输卵管切除术步骤无关。(C) 2013爱思唯尔公司版权所有。
Objective. The objective of this study is to compare ovarian function and surgical outcomes between patients affected by benign uterine pathologies submitted to total laparoscopic hysterectomy (TLH) plus salpingectomy and women in which standard TLH with adnexal preservation was performed.Methods. We retrospectively compared data of 79 patients who underwent TLH plus bilateral salpingectomy (group A), with those of 79 women treated by standard TLH without adnexectomy (sTLH) (group B). Ovarian reserve modification, expressed as the difference between 3 months post-operative and pre-operative values of Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), Antral Follicle Count (AFC), mean ovarian diameters and Peak Systolic Velocity (PSV), was recorded for each patient For each surgical procedure, operative time, variation of hemoglobin level (Delta Hb), postoperative hospital stay, postoperative return to normal activity, and complication rate were recorded as secondary outcomes.Results. According to our post-hoc analysis, this equivalence study resulted to have a statistical power of 96.8%. Significant difference was not observed between groups with respect to Delta AMH (p = 0.35), Delta FSH (p = 0.15), Delta AFC (p = 0.09), A mean ovarian diameters (p = 0.57) and Delta PSV (p = 0.61). In addition, secondary outcomes such as operative time (p = 0.79), Delta Hb (p 0.41), postoperative hospital stay (p = 0.16), postoperative return to normal activity (p = 0.11) and complication rate also did not show any significant difference.Conclusions. The addition of bilateral salpingectomy to TLH for prevention of ovarian cancer in women who, do not carry a BRCA1/2 mutations do not show negative effects on the ovarian function. In addition, no perioperative complications are related to the salpingectomy step in TLH. (C) 2013 Elsevier Inc. All rights reserved.