未成熟卵泡穿刺术治疗多囊卵巢综合征不孕患者的临床研究

Clinical study of imature follicle puncture in the treatment of infertility patients with polycystic ovarian syndrome

目的 探讨未成熟卵泡穿刺术（IMFP）治疗多囊卵巢综合征（PCOS）不孕患者的可行性和有效性.方法 选择2009年4月至2011年3月在山东省聊城市第二人民医院生殖科接受诊疗并确诊的PCOS不孕患者共149例,分为对照组（74例）和研究组（75例）.对照组应用炔雌醇环丙孕酮片治疗,l片/d,1个周期21 d,用药期间每4周复诊1次,3个周期后指导同房.研究组应用炔雌醇环丙孕酮片治疗3个周期（用药方案同对照组）,停药3个月内未见优势卵泡者,给予促排卵治疗后,行IMFP.分别记录2组治疗前后性激素水平、卵巢体积大小及窦卵泡数目变化以及治疗后月经恢复情况、排卵及妊娠率.结果 2组治疗后性激素水平均得到不同程度改善,但差异无统计学意义（P＞0.05）;研究组和对照组卵巢体积及基础窦卵泡计数治疗后较治疗前明显减少[研究组：（4.3±0.8）cm3比（5.5±0.4） cm3,（10.2±2.6）个比（13.9±2.3）个,对照组：（4.0±0.4） cm3比（4.4±0.4）cm3,（12.0±3.0）个比（14.3±3.1）个]（P＜0.05）,并且研究组卵巢体积及窦卵泡计数变化明显大于对照组[（4.0±2.9）cm3比（2.9±2.6）cm3,（14.2±5.4）个比（7.9±4.3）个]（P＜0.05）;研究组月经恢复、排卵及妊娠率明显高于对照组[50.1％（38例）比32.4％（29例）,排卵率为73.3％（55例）比55.4％（41例）,妊娠率为44.2％（33例）比28.3％（21例）]（均P ＜0.05）.结论 IMFP和炔雌醇环丙孕酮片在治疗PCOS不孕方面疗效均确切,但IMFP在减小卵巢体积、减少窦卵泡数、改善月经、恢复排卵及促进妊娠方面优于炔雌醇环丙孕酮片.

Objective To evaluate the efficacy and feasibility of transvaginal ultrasound-guided immature follicle puncture （IMFP） on polyeystic ovary syndrome （PCOS） with infertility.Methods One hundred and fortynine patients diagnosed of PCOS with infertility were included from April 2009 to March 2011.74 patients of control group had a piece of the oral desogestrel and ethinylestradiol tablets （diane-35）.Further consultation was performed every four weeks.The patients without domiminant follicle in 3 months after medicine administration were treated with IMFP after ovulation induction therapy.Serum hormone level,the change of the ovary volume and basic follicle number were recorded before and after treatment.Menstruation recovery ovulation and pregnancy rate were recorded after treatment.Results Serum hormone level was ameliorated but without statistical difference （P 〉 0.05） ; ovary volume and the basic follicle number were decreased in patients of both groups after treatment [study group：（4.3 ± 0.8） cm3 vs （5.5 ± 0.4） cm3,（10.2 ± 2.6） vs （13.9 ± 2.3）,control group：（4.0 ±0.4）cm3 vs （4.4 ±0.4）cm3,（12.0 ±3.0） vs （14.3 ±3.1）] （P 〈0.05） and there were significant differences in the rate of change of ovary volume and the basic follicle number between two groups （P 〈 0.05）.Menstruation recovery,ovulation and pregnancy were also improved significantly in both groups after treatment[50.1% （38 cases） vs 32.4% （29 cases）,73.3% （55 cases） vs 55.4% （41 cases）,44.2% （33 cases） vs 28.3% （21 cases）]（P 〈 0.05）.Conclusions The IMFP and oral contraceptive treatment are both feasible for PCOS with infertility.However,IMFP treatment is better than oral contraceptive regarding decreasing the basic follicle number,the ovary volume,menstruation recovery,spontaneous ovulation rate and the pregnancy rate.