腹腔镜卵巢子宫内膜异位囊肿剔除术对卵巢储备功能及生育的影响

Influence of Laparoscopic Cystectomy on Ovarian Reserve Function and Pregnantic Outcome in Women with Ovarian Endometriotic Cyst

目的探讨腹腔镜卵巢子宫内膜异位囊肿剔除手术对卵巢储备功能及生育的影响。方法 采用前瞻性对照研究,对照组为40例单侧卵巢成熟性囊性畸胎瘤及10例双侧卵巢成熟性囊性畸胎瘤行腹腔镜囊肿剔除术患者;试验组为126例卵巢子宫内膜异位囊肿腹腔镜囊肿(巧囊)剔除术患者,分为单侧巧囊<35岁(40例),单侧巧囊≥35岁(26例),双侧巧囊<35岁(41例)和双侧巧囊≥35岁(19例)4组。比较各组手术前、手术后24小时内以及手术后6个月血清卵泡刺激素(follicle stimulating hormone,FSH)和雌二醇(estradiol,E2)水平,术后6个月卵巢最大平面平均直径,并随访术后18个月妊娠结局。结果 双侧巧囊<35岁及≥35岁患者卵巢子宫内膜异位囊肿剔除术后24小时内FSH较术前明显增高(P<0.05),而E2明显减低(P<0.05)。而畸胎瘤对照患者及单侧巧囊<35岁及≥35岁患者手术前后各激素水平比较差异均无统计学意义(P(0.05)。双侧巧囊<35岁患者,术后6个月基础FSH恢复至正常范围者占77.8%,而双侧巧囊≥35岁患者中基础FSH恢复至正常范围者仅占53.3%,两组比较差异具有统计学意义(P<0.05)。术后6个月手术侧与未手术侧卵巢缩小率比较差异具有统计学意义(P<0.05)。术后18个月妊娠率非巧囊组(92.9%)明显高于巧囊组(45.2%)(P<0.05);单侧巧囊<35岁、单侧巧囊≥35岁、双侧巧囊<35岁及双侧巧囊≥35岁患者的妊娠率分别为60%、37.5%、46.2%和16.7%,各组比较差异具有显著意义(P<0.05),其中以双侧巧囊≥35岁患者的妊娠率最低。结论腹腔镜双侧卵巢子宫内膜异位囊肿剔除术对卵巢功能有一定程度的影响,但大部分年轻患者可以在术后6个月内恢复。对有生育要求的患者应注意围手术期卵巢功能的评估和卵巢的保护。

Objective To investigate the influence of laparoscopic ovarian cystectomy on ovarian reserve function and pregnantic outcome in women with ovarian endometriotic cyst.Methods A total of 176 women with ovarian cyst undergoing laparoscopic cystectomy were divided into six groups：40 patients with uni-lateral teratoma（con1）,10 patients with bilateral teratoma（con2）,40 patients with unilateral ovarian endometriotic cyst less than 35y（A）,26 patients with unilateral ovarian endometriotic cyst no less than 35y（B）,41 patients with bilateral ovarian endometriotic cyst less than 35y（C）,and 19 patients with bilateral ovarian endometriotic cyst no less than 35y（D）.Blood samples were obtained from patients before operation,24 hours after operation and on the second and third day of the menstrual cycle 6 months after operation.Mean ovarian diameter were evaluated by ultrasound 6 months after operation and pregnancy outcome was recorded in the following 18 months after the operation.Results In the bilateral groups（C and D）,the serum level of follicle stimulating hormone（FSH）increased significantly after the operation（P0.05）,while estradiol decreased significantly（P0.05）.No significant difference between pre-and post-operational hormone levels were observed in the unilateral groups（A and B）and control group Serum basal FSH recovered to normal 6 months after the operation in 77.8% of patients in group C and 53.3% in group D（P0.05）.The reduction of mean ovarian diameter six months after operation was significantly different between the affected and contralateral ovaries（P0.05）.During the follow-up,the pregnancy rate was 92.9% in controlled group,compared to 45.2% in the endometriosis group（P0.05）and 60%,37.5%,46.2%,and 16.7%,respectively,for group A,B,C,and D.Conclusion The ovarian reserve function decreases after laparoscopic ovarian cystectomy in women with ovarian endometriotic cyst.However,most young patients recover after 6 months.Peri-operative ovarian function assessment and ovarian protection should be carefully designed and performed for women who intend to get pregnant.