腹腔镜术中不同剥离方式治疗卵巢子宫内膜异位症的疗效比较研究

Comparative analysis of different kinds of laparoscopic decollement operation in the treatment of ovarian endometriosis

目的:探讨腹腔镜术中应用钝性与锐性剥离对卵巢子宫内膜异位症患者皮质剥除情况、激素指标及妊娠结局的影响。方法:选取2015年4月至2017年4月收治的110例卵巢子宫内膜异位症患者,以随机数字表法分为对照组(n=55)与观察组(n=55),分别采用钝性与锐性剥离方式;比较两组患者卵巢不同部位皮质剥除率,卵巢皮质与病灶剥除厚度,手术前后患侧卵巢窦状卵泡数、卵巢体积、卵泡刺激素(follicle-stimulating hormone,FSH)、促黄体生成素(luteotropic hormone,LH)、雌二醇(estradiol,E2)、抗苗勒氏管激素(anti-Mullerian hormone,AMH)水平,以及术后6个月妊娠率。结果:观察组卵巢门皮质剥除率及中间、卵巢门部位病灶与卵巢皮质剥除厚度均低于对照组(P<0.05),术后患侧卵巢窦状卵泡数量、卵巢体积均高于对照组(P<0.05);两组手术前后FSH、LH及E2水平差异无统计学意义(P>0.05);观察组术后AMH水平、术后6个月妊娠率高于对照组(P<0.05)。结论:腹腔镜术中锐性剥离治疗卵巢子宫内膜异位症可显著减轻卵巢门皮质剥除程度,避免卵泡丢失,改善AMH水平,并有助于提高妊娠率,疗效优于钝性剥离。

Objective： To investigate the influence of laparoscopic blunt and acute decollement operation on cortex decollement situation,hormone index and pregnancy outcome of patients with ovarian endometriosis. Methods： One hundred and ten patients with ovarian endometriosis were chosen from Apr. 2015 to Apr. 2017 and randomly divided into two groups,including control group（ 55 patients） with blunt decollement and observation group（ 55 patients） with acute decollement. The cortical ablation rate in ovarian different position,the stripping thickness of ovarian cortex and lesion,the number of ovarian antral follicles,ovarian volume,the levels of follicle-stimulating hormone（ FSH）,luteotropic hormone（ LH）,estradiol（ E2） and anti-Mullerian hormone（ AMH） before and after operation and the pregnancy rate in 6 months after operation were compared between the two groups. Results： The cortical ablation rate in hilus ovarii,stripping thickness of middle lesions,ovarian portal lesions and ovarian cortex of observation group was significantly lower than that of control group（ P〈0. 05）. The antral follicle count of affected side and ovary volume of observation group after operation were significantly higher than those of control group（ P〈0. 05）. There were no significant differences in the levels of FSH,LH and E2 before and after treatment between the two groups（ P〉0. 05）. The level of postoperative AMH and the pregnancy rate in 6 months after operation of observation group was significantly higher than that of control group（ P〈0. 05）. Conclusions： Compared with blunt decollement,laparoscopic acute decollement operation in the treatment of ovarian endometriosis can efficiently reduce the stripping degree of ovarian portal cortex,avoid follicles loss,improve the levels of AMH and increase the pregnancy rate.