腹腔镜卵巢子宫内膜异位囊肿手术对卵巢储备功能影响的研究

Influence on the ovarian reserves function after laparoscopic operation combined with GnRH on the women with ovarian endometrioma

目的探讨腹腔镜卵巢子宫内膜异位囊肿剥除术联合促性腺激素激动剂(GnRH-a)治疗对卵巢储备功能的影响。方法前瞻性队列研究,实验组:卵巢子宫内膜异位囊肿行腹腔镜囊肿剥除术105例。实验组分为4组:A组:单侧卵巢子宫内膜异位囊肿,囊肿直径<5 cm(33例);B组:单侧卵巢子宫内膜异位囊肿,囊肿直径≥5cm(24例);C组:双侧卵巢子宫内膜异位囊肿,双侧囊肿均直径<5 cm(27例);D组:双侧卵巢子宫内膜异位囊肿,至少一侧囊肿直径≥5 cm(21例)。对照组:行腹腔镜下单侧卵巢畸胎瘤(成熟性囊性畸胎瘤)剔除术(20例);比较各组手术前后血清卵泡刺激素(FSH)、黄体生成激素(LH)、雌二醇(E2)的变化,并根据巧囊的大小和类型分层分析。随访Ⅲ期患者术后6个月及Ⅳ期患者第1次月经复潮后,术后1年基础FSH的恢复情况、月经恢复情况及自然妊娠情况。结果 C、D两组卵巢子宫内膜异位囊肿剥除术后FSH较术前明显增高(P<0.05),E2明显减低(P<0.05),LH明显减低(P<0.05)。对照组及A、B组手术前后各激素水平差异均无统计学意义,分层分析单侧卵巢子宫内膜异位囊肿年龄及类型,各组内组间激素水平变化亦无明显差异。C组患者术后1年基础FSH恢复至正常范围内占85.3%,而D组患者基础FSH恢复至正常范围内仅占60.2%,差异有统计学意义(P<0.05)。A、B、C组术前不孕患者术后妊娠率明显高于对照组,差异有统计学意义(P<0.05),D组术前不孕患者术后妊娠率低于对照组。结论腹腔镜双侧卵巢子宫内膜异位囊肿剥除术联合GnRH-a治疗对卵巢储备功能有一定的影响,但大部分患者可在术后1年内恢复,不孕症患者术后加用GnRH-a等药物则可明显提高术后妊娠率,但与临床分期相关。

Objective To discuss the influence on the ovarian reserves function after laparoscopic operation combined with gonadotropin-releasing hormone（GnRH） on the women with ovarian endometrioma.MethodsA total of 125 women with ovarian cyst,undergoing laparoscopic cystectomy were included.These patients were divided into five groups： 20 patients with unilateral teratoma（control）,groups A（n=33,unilateral ovarian endometrioma,D≤5 cm）,groups B（n=24,unilateral ovarian endometrioma,D5cm）,groups C（n=27,bilateral ovarian endometrioma,D≤5 cm）,groups D（n=21,bilateral ovarian endometrioma,at lest one side D5cm）.Baseline levels of serum follicle stimulating hormone（FSH）,luteinizing hormone（LH） and estrogen（E2） were in all cases before,six months and one years after operations,and the menses were observed one year after operation.ResultsIn the bilateral groups（C and D）,the serum level of FSH increased significantly after the operation（P0.05）,while E2 decreased significantly（P0.05）,for LH decreased significantly（P0.05） one month after the operation.ConclusionIt suggested that ovarian reserve function would be decreased in laparoscopic bilateral ovarian endometrioma.And most patients recovered after one year,and the rate of natural pregnancy increased after the operation.Barrenness patients could increase the pregnancy rate after adding GnRH-a medicine based on the clinical staging.