腹腔镜下单极电针烧灼治疗多囊卵巢综合征

Insulated Needle Cautery under Laparoscopy for Polycystic Ovarian Syndrome

目的 评估对克罗米芬耐药的多囊卵巢综合征的不孕妇女进行腹腔镜下单极电针烧灼、穿刺治疗后的行经情况、排卵率、生殖结果及粘连形成情况。 方法 对 2 8例克罗米芬耐药的多囊卵巢综合征的不孕妇女行腹腔镜下单极电针烧灼、穿刺双侧卵巢 ,术后监测月经情况、自发排卵率、妊娠率、粘连形成情况。 结果 术后月经规则者10 0 % ,自发排卵发生率 85 .7% ( 2 4/2 8) ,术后受孕率 42 .8% ( 12 /2 8) ,对 4例术后 6～ 12个月又出现闭经、月经稀发 ,经克罗米芬治疗无效的未孕妇女进行了第二次腹腔镜手术 ,发现 2例有卵巢表面微小、膜状疏松粘连 ,2例第二次手术后自然妊娠。 结论 腹腔镜下单极电针烧灼、穿刺双侧卵巢是治疗对克罗米芬耐药的多囊卵巢综合征所致无排卵的有效治疗方法 ,手术方便、易行 ,术后无卵巢过度刺激综合征发生 ,手术所致卵巢表面的创伤小 ,术后仅少数病人发生卵巢表面轻度粘连 ,对手术治疗后复发病人行再次手术仍然有效。

Objective To evaluate the menstruation, the ovulation rate, the reproductive outcome, and adhesion formation after laparoscopic treatment for polycystic ovarian syndrome (PCOS) in the infertile women. Methods 28 clomiphene-resistant anovulatory women with PCOS were treated with laparoscopic ovarian drilling using an insulated needle cautery. The menstruation, ovulatory rate, pregnancy rate, and adhesion formation were measured after the surgery. Results After the surgery, regular menstruation occurred in 100% of the patients. Ovulation occurred spontaneously in 85.7% of the patients (24/28). The conception rate after surgery was 42.8%. Of 4 women who underwent a second laparoscopy, 2 women were found to be free of adhesion, and the other 2 women had minial membranous periovarian adhesion on the ovarian surface. No ovarian hyperstimulation sydrome occurred. Conclusions Laparoscopic ovarian drilling is an effective treatment in clomiphene-resistant anovulatory women with PCOS. The use of insulated needle cautery is associated with a minimal amount of adhesion formation.