不同手术方式剥除卵巢子宫内膜异位囊肿对体外受精-胚胎移植术结局的影响

Effect of different operation ways to excision of ovarian endometriomas on IVF-ET outcomes

目的探讨不同手术方式剔除卵巢子宫内膜异位症囊肿对卵巢控制性超促排卵(controlledovarianhyperstim-ulation,COH)的反应及体外受精-胚胎移植术(invitrertilizationandem bryotransfer,IVF-ET)助孕患者结局的影响。方法对67例既往开腹或腹腔镜确诊的子宫内膜异位症合并不育患者行体外受精-胚胎移植术COH和助孕结局进行回顾性分析。其中A组:21例曾行腹腔镜卵巢子宫内膜异位囊肿剔除术,B组:16例曾行开腹卵巢子宫内膜异位囊肿剔除术,C组:30例为未行囊肿剔除术的子宫内膜异位症患者。结果两种手术方式对COH中获卵数、受精率、优质胚胎数、移植胚胎数、妊娠率与对照组相比无显著性差异(P>0.05)。促性腺激素用量及用药天数明显多于对照组;两种手术组的窦卵泡数均少于非手术组(P<0.05);FSH、E2均高于非手术组(P<0.05),而两种手术组间无显著差异(P>0.05)。患者手术侧卵巢与未手术侧相比,卵巢虽小,但无显著性差异;窦卵泡数,HCG注射日直径≥14mm的卵泡数均明显少于对照组(P<0.05)。结论不同手术方式剔除卵巢子宫内膜异位症囊肿对IVF-ET结局无明显影响,但可影响卵巢功能,减低卵巢储备能力。

Objective： To investigate different operating ways to excision of ovarian endometriosis prior to IVF-ET affects ovarian response of controlled ovarian hyperstimulation and fertility outcomes.Methods A retrospective study on 67women with ovarian endometriomas（previously diagnosed by open or laparoscopic surgery） receiving COH for IVF-ET regarding their outcomes of assisted reproduction.A group：21 patients had received a laparoscopic cystectomy;B group：16patients had undergone an open cystectomy;C group：30 patients had been untreated with cystectomy.Results Both laparoscopic and open cystectomy of ovarian endometriomas are no significant difference in number of superiority follicles,number of oocytes obtained,number of nomally developed embryos,number of embryos transferred and pregnancy rate.Numbers of antralfollicles in the A and B group were significant fewer than the C group（P〈0.05）.There was no difference in the dose and duration of FSH application between laparoscopic and open cystectomy group（P〉0.05）,but the does and duration of FSH application in the laparoscopic and open cystectomy groups were significantly more than the control group（P〈0.01）.The numbers of antralfollicles and preovulative follicles were statistically different between the study and control groups（P〈0.05）.Conclusion Both laparoscopic and open cystectomy of ovarian endometriomas maycause damage to ovarian function.There was no difference in the two operation groups on IVF-ET outcomes.