腹腔镜卵巢打孔术治疗难治性多囊卵巢综合征不孕症临床研究

Clinical study of laparoscopic ovarian drilling in the treatment of refractory polycystic ovary syndrome

目的:探讨腹腔镜卵巢打孔术(LOD)治疗难治性多囊卵巢综合征不孕症(RIPCOS)的临床效果。方法:68例RIPCOS患者按随机数字表法分为实验组和对照组各34例。对照组予坤泰胶囊、来曲唑片、尿促性腺激素及人绒毛膜促性腺激素等药物治疗;实验组采用LOD治疗,术后卵泡发育仍不成熟,予克罗米芬治疗。两组疗程均为3个月。结果:(1)实验组34例患者手术全部成功,手术时间(32.9±5.1)min,术中出血量(8.8±1.7)ml,住院天数(5.4±1.0)d;(2)治疗后1、3及6个月两组血清黄体生成素、睾酮、雌二醇、体重指数、基础体温、卵巢容积及窦卵泡数均逐渐下降,卵泡直径、成熟卵泡数、月经正常率、排卵率及受孕率均逐渐上升,实验组改善更加明显,与对照组比较差异均有统计学意义(P<0.01或P<0.05)。结论:LOD治疗RIPCOS具有疗效好、损伤小、恢复快、不良反应少等优点,可以明显提高排卵率和受孕率,值得在临床上推广使用。

Objective： To explore the clinical effect of laparoscopic ovarian drilling（ LOD） in the treatment of refractory polycystic ovary syndrome（ RIPCOS）.Methods： Sixty-eight cases of RIPCOS were randomly divided into experimental group and control group with 34 cases in each group.The control group was given KUNTAI capsule,Letrozol Tablets,urinary gonadotropin and chorionic gonadotrophin therapy.The experimental group was treated with LOD and their ovarian follicular development was still immature after operation and treated with clomiphene citrate.The course of treatment in two groups was 3 months.Results：（ 1） In the experimental group,34 patients were operated successfully,the operation time was（ 32.9 ± 5.1） min,the amount of bleeding was（ 8.8 ± 1.7） ml and the length of hospital stay was（ 5.4 ± 1.0） d;（ 2） After treatment for 1,3 and 6 months,the levels of serum luteinizing hormone,testosterone,estradiol,body mass index,basal body temperature,ovarian volume and the number of the antral follicle decreased gradually in the two groups,while follicular diameter,mature follicle number,menstrual normal rate,ovulation and pregnancy rate increased gradually.Compared with the control group,the experimental group improved more obviously,the differences being statistically significant（ P 〈 0.05 or P〈 0.05）.Conclusion： Laparoscopic ovarian drilling has the advantages of good curative effect,minimal invasive,rapid recovery and fewer adverse reactions in the treatment of refractory polycystic ovary syndrome infertility.It can significantly improve the ovulation and pregnancy rate.Thus it is worth promoting in clinical application.