AMH在卵巢囊肿术后对卵巢储备影响的评价作用

Anti-müllerian hormone as a new mark of ovarian reserve in laparoscopic ovarian cystectomy

目的：探讨 AMH 在腹腔镜卵巢囊肿剔除术中卵巢创面采用电凝或缝合止血方法对卵巢储备功能影响的评价作用。方法：选取2008年5月至2013年7月因单侧卵巢囊肿行腹腔镜下卵巢囊肿剔除术的38例患者,随机将患者分为缝合组（20例）、电凝组（18例）,术中创面止血分别采用缝合法和电凝法。同时选取23例正常育龄妇女为对照组。于术前1个月及术后第1、3、6个月检测基础性激素水平（AMH、FSH、LH、E2）,月经周期第3-5天行阴道彩色多普勒超声检查,检测卵巢间质动脉血流阻力指数（RI）及窦卵泡数（AFC）。结果：3组患者的术前一般情况和卵巢储备功能比较,差异均无统计学意义（P〉0.05）。与正常对照组比较,缝合组、电凝组囊肿侧卵巢术后1月的 AFC 明显减少,术后1、3、6月 AMH 水平明显下降,术后1月 E2水平增高,差异均有统计学意义（P 均〈0.05）；缝合组、电凝组术后1、3、6月卵巢间质动脉 RI、LH、FSH 水平与正常对照组比较,差异均无统计学意义（P〈0.05）。结论：卵巢囊肿术后,AMH 较其他评价卵巢储备的指标明显下降,在其他指标恢复术前水平后仍提示卵巢储备受损。提示 AMH 可用于临床评价卵巢储备。

Objective：To investigate the role of AMH in the evaluation of ovarian re-serve on the ovarian wound was treated by electrocoagulation and suture hemostasis in the lapa-roscopic ovarian cystectomy. Methods：Thirty-three patients with unilateral benign ovarian cyst from May 2008 to July 2013 were divided into 2 groups randomly to undergo laparoscopic cys-tectomy. According to hemostatic method,one is electrocoagulation group （n = 18）,another is suture group（n =20）. Twenty-three females in the same age were selected as the normal control group （NCG）. In early follicular phase （day 3） of the cycle preceding the operation and 1,3, 6 months after the laparoscopic cystectomy,serum levels of AMH FSH,E2 and LH,AFC were detected in the 3 groups. The ovarian arterial resistance index （RI） and ovarian antral follicle count （AFC） were tested by transvaginal color doppler ultrasonic sonography at the day 3-5 of same menstrual cycle. Results：There were no significant difference in preoperative general con-ditions and ovarian reserve among the 3 groups （P〉0. 05）. The AFC of suture group and coag-ulation group in the ovary ovarian cyst after 1 month of operation was significantly reduced than that in the NCG,the serum AMH levels of suture group and coagulation group after 1,3,6 months of operation were obviously lower than that in the NCG,the serum E2 levels of coagula-tion group after operation 1 month were higher than that in the NUG （P〈0. 05）. Meanwhile,no significant difference in ovarian arterial RI,FSH,LH were found among the 3 groups after 1,3, 6 months of operation （P〈0. 05）. Conclusion：This study demonstrated that the postoperative serum AMH levels were obviously decreased compared with other evaluation of ovarian reserve index,the serum AMH levels suggested that ovarian reserve damaged which recovered to the preoperative levels. Therefore AMH could be used in clinic to evaluate the ovarian reserve.