超声引导经阴道卵巢间质激光治疗多囊卵巢综合征排卵障碍

Ultrasonographic guided transvaginal ovarian interstitial laser treatment in patients with polycystic ovary syndrome

目的评价经阴道超声引导卵巢内激光治疗后多囊卵巢综合征（PCOS）患者血激素水平的变化和临床效果。方法23例对克罗米芬和促性腺激素诱发排卵治疗无反应，或出现卵巢过度刺激综合征的PCOS不孕患者，在超声引导下行经阴道卵巢间质YAG激光治疗。长穿刺针送入400μm光纤，每侧卵巢内激光凝固3～4个点，观察术后半年内每个病例的血清黄体生成素（LH）／卵泡刺激素（FSH）比值、睾酮、小卵泡数目的变化及自发排卵率和妊娠率。结果治疗23例，随访22例，其中19例术后发生自发规律排卵和月经，自发排卵率86．4％（19／22）。术后2、4、6个月平均血清LH和睾酮水平分别为（4．62±1．47）IU／L和（2．46±1．63）nmol／L，显著低于术前的（13．89±3．62）IU／L和（5．37±3．09）nmol／L（P〈0．001）；平均LH／FSH值为0．87±0．19，显著低于术前的2．78±1．21（P〈0．001）；单侧卵巢内小卵泡数为（15．85±3．97）个，显著少于术前的（25．35±5．76）个（P〈0．001）。共有8例妊娠，累计妊娠率36．3％（8／22）。结论超声引导经阴道卵巢间质激光治疗能改善PCOS患者血激素紊乱状态，是治疗PCOS排卵障碍的有效方法。

Objective To assess the effectiveness of ultrasonographic guided transvaginal ovarian interstitial laser treatment in anovulatory patients with polycystic ovary syndrome（PCOS）. Methods Twenty-three PCOS women with clomiphene citrate-resistant who suffered from ovarian hyperstimulation syndrome in previous ovulation induction with gonadotrophin underwent transvaginal ovarian interstitial laser treatment. By means of 17 G/35 cm needle,a fibre-optical of 400 μm in diameter was carried and 3-4 points of coagulation were done in each ovary. The monitoring items included serum LH/FSH ratio, the testosterone （T） level, the number of subcapsular follicles, spontaneous ovulation rate and pregnancy rate. Results Spontaneous ovulation and menstruation occurred regularly in 19 out of 22 patients （86.4%） during six postoperative months（1 case failure to follow up）. The mean serum LH and T monitored duing postoperative 2nd, 4th and 6th month were （4.62±1.47） IU/L and （2.46±1.63） nmol/L respectively, significantly lower than those of preoperative [-（13.89±3.62） IU/L and （5.37±3.09） nmol/L, P 〈 0.001]; The mean LH/FSH ratio of 0.87±0.19 was significantly （P 〈 0.001） lower than that of preoperative 2.78±1.21. The number of subcapsular follicles in unilateral ovary was 15.85±3.97, greatly less than that of preoperative （25.35±5.76, P 〈 0.001）. With 36.3 % （8/22） of pregnancy rate, the singleton pregnancy occurred in 8 women. Conclusions Ultrasound-guided transvaginal ovarian interstitial laser treatment appears effective in improving hormonal paramet and inducing ovulation and successful pregnancy in women with clomiphene-resistant PCOS.