不孕症卵巢良性囊肿及手术剔除后卵巢功能评价指标的变化

The changes of ovarian function assessment indexes in infertile patients with benign ovarian cyst after oophorocystectomy

目的探讨不孕症妇女卵巢良性囊肿及手术剔除后卵巢功能评价指标的变化。方法选择2013年7月至2014年2月中山大学孙逸仙纪念医院生殖中心第1周期体外授精(in vitro fertilization,IVF)/卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)助孕的不孕症伴发卵巢良性囊肿及手术剔除的患者50例作为研究组,同期因输卵管性或男方因素不孕妇女50例作为对照组,比较两组患者的卵巢功能评价指标和助孕结局。结果未行手术治疗囊肿者卵巢体积[(18.64±14.67)m L]较对照组[(6.19±3.58)m L]明显增大(P<0.05),临床妊娠率(87.50%)高于对照组(45.65%)(P<0.05)。卵巢囊肿手术剔除者抗苗勒氏管激素水平[(2.35±2.02)ng/m L]和窦卵泡个数[(10.67±6.04)个]低于对照组[(3.84±2.84)ng/m L、(13.88±7.32)个](P<0.05)。无论是否采用手术治疗卵巢囊肿,控制性卵巢刺激时研究组促性腺激素总用量均显著高于对照组(P<0.05)。卵巢囊肿手术剔除者获卵数[(9.50±6.68)个]少于对照组[(12.54±5.50)个](P<0.05);单侧卵巢囊肿剔除者手术侧卵巢获卵数[(4.22±3.63)个]少于健侧卵巢[(6.00±4.49)个](P<0.05)。结论直径<5 cm的卵巢良性囊肿存在没有对不孕妇女卵巢储备功能造成影响,手术剔除后卵巢储备功能呈现下降的趋势,但无论是否采取手术治疗,患者的生殖潜能都未受到明显损害。

Objective To explore the changes of ovarian function assessment indexes in infertile patients with benign ovarian cyst after oophorocystectomy. Methods A total of 50 infertile patients with benign ovarian cyst and oophorocystectomy undergoing the first fresh cycle of in vitro fertilization （IVF） / intracytoplasmic sperm injection （ICSI） from July 2013 to February 2014 in Sun Yat -Sen Memorial Hospited of Sun Yat - Sen University Reproductive Centre were enrolled as the study group, meanwhile 50 infertile patients with tubal or male factors were selected as the control group. The ovarian function assessment indexes and treatment outcomes were compared between the two groups. Results Ovarian volumes were significantly larger [ （ 18. 64 ±14. 67） mL] and clinical pregnancy rates （87. 50 % ） in patients with benign ovarian cyst without operation were significantly higher than the control group[ （6. 19 ±3. 58） mL, 45.65 % ] （ P 〈 0. 05 ）. In patients with oophorocystectomy, serum anti - Mttllerian hormone level [ （2.35± 2.02 ） ng/mL ] and antral follicle count （ 10.67 ±6.04 ） were obviously lower than the controls [ （ 3.84 ± 2. 84 ） ng/mL, （ 13.88 ≡ 7. 32 ） ] （ P 〈 0.05 ）. A higher total gonadotropin consumption was observed in the study group than in the control group （ P 〈 0. 05 ）. The number of oocyte retrieved in patients with previous oophorocystectomy （9. 50±6. 68） was significantly less than in patients of the control group （12. 54 ±5.50） （P 〈0.05）. For patients with unilateral oophorocystectomy, the number of oocyte retrieved from affected ovary（ 4. 22 ±3.63） was also less than those from contralateral ovary （6. 00 ±4. 49） （P 〈 0.05）. Conclusion In infertile patients, benign ovarian cysts 〈 5 cm in diameter were not associated with a reduction of ovarian reserve, after oophorocystectomy ovarian reserve function was impaired, however, capacity to conceive was unaffected regardless of oophorocystectomy.