破裂型卵巢巧克力囊肿腹腔镜术前行GnRH-a预处理的临床研究

Clinical study on GnRH-a pretreatment of ruptured ovarian chocolate cysts before laparoscopic surgery

目的:观察破裂型卵巢巧克力囊肿患者于腹腔镜手术前行GnRH-a预处理对手术及预后的影响。方法:27例卵巢巧克力囊肿破裂患者先予以GnRH-a治疗3个月,再行腹腔镜卵巢巧克力囊肿剥除术(观察组);未预行GnRH-a治疗直接行腹腔镜手术的18例卵巢巧克力囊肿破裂患者作为对照组。评估并对比两组手术时间、术中出血量、术后肛门排气时间、术后住院时间。两组患者术后继续GnRH-a治疗3个周期,并于术后3个月、6个月、1年、2年进行随访,观察卵巢储备功能、囊肿复发、妊娠等情况。结果:观察组手术时间、术中出血量、术后肛门排气时间均较对照组明显降低,术后住院时间两组差异无统计学意义。术后随访,观察组27例患者中1例双侧卵巢巧克力囊肿患者月经恢复后复查FSH水平,轻度升高,予以克龄蒙治疗3个月后正常;余26例卵巢储备功能正常,术后随访2年,1例复发,16例妊娠。对照组随访2年,18例患者中5例复发,FSH水平轻度升高2例,15例不孕患者中5例妊娠。结论:破裂型卵巢巧克力囊肿经GnRH-a预处理后再行腹腔镜手术,由于病灶已萎缩,易于剥除,且血运不丰富,出血较少,降低了手术难度及术后复发率,减少了手术对卵巢功能的影响及损伤肠管、输尿管等重要脏器的风险。

Objective：To investigate the influence of GnRH-a pretreatment before laparoscopic surgery on operation and prog- nosis of patients with ruptured ovarian chocolate cyst. Methods ： The observation group included 27 patients diagnosed as ruptured ovari- an chocolate cyst. 3 doses GnRH-a pretreatment was given before laparoscopic ovarian cystectomy. The control group included 18 pa- tients diagnosed as ruptured ovarian chocolate cyst, who directly underwent laparoscopic surgery without GnRH-a pretreatment. After surgery, the operative time, intraoperative blood loss, postoperative anal exhaust time and hospital stay were assessed and compared be- tween the 2 groups. And all patients accepted 3 months postoperative treatment with GnRH-a. The postoperative follow-ups were ap- plied 3 months,6 months, 1 year and 2 years after operation,the ovarian reservation function, cyst recurrence,pregnancy were observed. Results：The operative time, blood loss, postoperative anal exhaust time in observation group were significantly less than those in the control group, but there was no difference in the postoperative hospital stay. In observation group, FSH level of 1 case （ 1/27 ） mildly el- evated after surgery and returned to normal after 3 months treatment of Climen ; the ovarian reservation function of other 26 patients were normal;1 recurrence case （1/27） , 16 pregnancy cases （16/24） were observed within postoperative follow-up of 2 years. The corre- sponding results in control group were 5 recurrence cases （5/18）, 2 FSH mildly elevated cases （2/18）, and 5 pregnancy cases （5/15）. Conclusions ： Due to atrophic lesions, easy stripping, decreased blood supply, less bleeding, GnRH-a pretreatment of ruptured ovarian chocolate cysts before laparoscopic surgery can reduce the operational difficulty and the impact on ovarian function,lower the re- currence rate and the risk of intestinal and ureter injury.