经阴道腹腔镜卵巢打孔术治疗多囊卵巢综合征

Transvaginal Hydrolaparoscopic Ovarian Drilling in the Treatment of Polycystic Ovarian Syndrome

目的探讨经阴道腹腔镜卵巢打孔术治疗多囊卵巢综合征的有效性和安全性。方法2008年2-11月对11例氯米芬（clomiphene citrate,CC）抵抗的多囊卵巢综合征合并不孕症行经阴道腹腔镜卵巢打孔术。年龄（29.3±3.7）岁,体重指数（24.3±8.3）kg/m^2。注水腹腔镜器械从阴道后穹隆置镜,生理盐水作为介质,F5双极电针进行打孔术。针进入卵巢皮质内0.8cm,电凝10-15s。患者每侧打孔5-15个。结果双侧卵巢打孔数（17±6）个。无并发症发生。术前、术后促黄体生成素（luteinizing hormone,LH）水平分别为（14.7±4.5）IU/L vs（10.5±3.7）IU/L（t=2.389,P=0.027）;促卵泡生成素（follicle stimulating hormone,FSH）水平（7.1±6.4）IU/L vs（6.4±1.7）IU/L（t=1.007,P=0.326）;雄烯二酮（androstendione,A）（12.2±4.4）nmol/L vs（8.9±3.0）nmol/L（t=2.104,P=0.048）。11例术后随访时间2-9个月,自然月经恢复6例（54.5%）,其中排卵恢复3例（27.3%）,自然妊娠2例（18.2%）。未恢复排卵的8例中,5例CC或促性腺激素促排卵,已有1例妊娠;1例接受体外受精-胚胎移植技术,未妊娠;2例仍在追踪观察中。结论经阴道腹腔镜卵巢打孔术治疗CC抵抗的多囊卵巢综合征是安全有效的。

Objective To evaluate the efficacy and safety of transvaginal hydrolaparoscopic ovarian drilling for treatment of the polycystic ovary syndrome（PCOS）in clomiphene citrate-resistant infertile women.Methods Between February 2008 and November 2008,11 clomiphene citrate-resistant anovulatory women with PCOS mean age：（29.3±3.7）years,mean body mass index：（24.3±8.3）kg/m2] were enrolled in this study.Transvaginal hydrolaparoscopy using a F5 bipolar needle was performed on the patients to create 5-15 holes with a free length of 0.8 cm and a diameter of 0.2 mm in each ovary（electrocoagulation time 10-15 sec）.Results A mean of（17±6）holes were made in both the ovaries in the patients.No surgical complications occurred.The levels of LH,FSH,and androstenedione dropped from（14.7±4.5）IU/L,（7.1±6.4）IU/L,and（12.2±4.4）nmol/L to（10.5±3.7）IU/L,（6.4±1.7）IU/L,and（8.9±3.0）nmol/L（t=2.389,P=0.027;t=1.007,P=0.326;and t=2.104,P=0.048）respectively after the operation.The patients were followed up for 2 to 9 months,during the period 6（54.5%）patients recovered spontaneous menstruation,among which 3 recovered ovulatory cycles（27.3%）and 2（18.2%）had spontaneous pregnancy.In the other 8 patients who didn＇t recover spontaneous menstruation,5 cases received CC or FSH（one of them was pregnant after the treatment）;1 case was not pregnant though received IVF;and 2 are still in follow-up.Conclusions Transvaginal hydrolaparoscopic ovarian drilling is safe and effective for clomiphene citrate-resistant infertile women.