卵巢囊肿不同处理方式对卵巢储备功能及体外受精-胚胎移植助孕结局的影响

Effects of different treatments of ovarian cysts on ovarian reserve function and outcomes of In vitro fertilization embryo transfer

目的:探讨经B超引导下囊肿穿刺和腹腔镜下卵巢巧克力囊肿剥除术对卵巢和子宫内膜异位囊肿患者卵巢储备功能、体外受精-胚胎移植(IVF-ET)助孕结局的影响。方法:回顾性收集2016年1月—2017年1月本院收治的卵巢子宫内膜异位囊肿合并不孕患者85例临床资料,患者均行IVF-ET治疗,根据助孕前手术方法不同分组,行B超引导下囊肿穿刺治疗的36例纳入穿刺组,行腹腔镜下卵巢巧克力囊肿剥除术的49例纳入剥除组,两组术后3～12个月行IVF治疗,比较两组卵巢功能储备、Gn用药情况和HGG注射日相关指标,IVF-ET助孕结局。结果:两组年龄、囊肿直径、不孕年限和体质量指数比较无差异(P>0.05);穿刺组术后血清E_2、LH、FSH水平显著高于剥离组,窦卵泡数显著少于剥离组(均P<0.05);两组Gn用药总量和用药时间相当(P>0.05);剥离组HGG日血清E_2水平低于穿刺组,≥14mm卵泡数少于穿刺组(P<0.05);两组HGG日子宫内膜厚度比较无明显差异,两组优质胚胎率、受精率、临床妊娠率和完成移植周期率比较无明显差异(均P>0.05);剥离组自然流产率低于穿刺组(P<0.05)。结论:B超引导下囊肿穿刺对卵巢子宫内膜异位囊肿患者卵巢储备功能影响小于腹腔镜下卵巢巧克力囊肿剥除术,两种治疗方法妊娠率接近,但B超引导下囊肿穿刺自然流产率相对高,临床可结合患者情况选择手术方式。

Objective： To explore the influence of ovarian cyst puncture guided by B ultrasound or laparoscopic ovarian chocolate cystectomy on ovarian reserve function and outcomes of In vitro fertilization embryo transfer （IVF-ET） of patients with ovarian endometriosis cysts. Methods.. 85 infertile women with ovarian endometriosis cysts treated in the third people＇s hospital of Baoji city from January 2016 to January 2017 were included as subjects, and all included women were given IVF-ET treatment 3 to 12 months after operation. According to different ovarian endometriosis cysts treatment, the patients were divided into group A （49 cases underwent laparoscopic ovarian chocolate cystecto- my）, and group B （36 cases underwent ovarian cyst puncture guided by B ultrasound）. The functional reserve, Gn ad- ministration, the relevant indicators on the HGG injection day, and outcomes of the IVF-ET were compared between the two groups. Results.. There were no significant difference in age, cystic diameter, infertility term, and body mass index （BMI） of women between the two groups （P〉0.05）, but the levels of serum E2, LH and FSH of women in group B were significant higher than those of women in group A （P〈0.05）, the number of antral follicles of women in group B was significant less than that of women in group A （P〈0.05）. The total amount of Gn used and the time of Gn used in the two groups were similar （P〉0.05）, but level of serum Ez of women in group A was significant lower than that of women in group B （P〈0.05）, and the number of follicles diameter ≥14 mm of women in group A was significant less than that of women in group B （P〈0.05）. There were no significant different in thickness of endome- trium on HCG injection day, the rate of high quality embryos, fertilization rate, clinical pregnancy rates, and rate of completed transplant cycles between the two groups （P〉0.05）. The rate of spontaneous abortion in group A was sig- nificantly lower than that in group B （P〈0.05）. Conclusion： Ovarian cyst puncture guided by B ultrasound for treating infertile women with ovarian endometriosis cysts has tess effect on ovarian reserve function when compared to laparo- scopic ovarian chocolate cystectomy. Women with ovarian endometriosis cysts experienced these two operations have similar pregnancy rates, but women experienced ovarian cyst puncture guided by B ultrasound have higher spontaneous abortion rate. Women with ovarian endometriosis cysts should choose appropriate treatment based on their situation.