GnRH-a对卵巢子宫内膜异位囊肿腹腔镜剔除术病人卵巢功能的作用

EFFECT OF GONADOTROPIN-RELEASING HORMONE AGONIST ON OVARIAN FUNCTION IN PATIENTS UNDERGOING LAPAROSCOPIC OVARIAN ENDOMETRIOSIS CYST REMOVAL

目的探讨术前使用促性腺激素释放激素激动剂(GnRH-a)亮丙瑞林对行腹腔镜卵巢子宫内膜异位症(EMs)囊肿剔除术病人卵巢功能的作用。方法选择行腹腔镜卵巢EMs囊肿剔除术的病人180例,随机分为2组,各90例。研究组术前应用亮丙瑞林2个周期后行腹腔镜卵巢EMs囊肿剔除术,对照组直接施术,术后均未再给予亮丙瑞林治疗。检测两组病人术前血清卵泡刺激素(FSH)、雌二醇(E2)、FSH/黄体生成素(LH)、抗苗勒管激素(AMH)水平,记录术中情况及标本囊壁残留卵泡情况,用免疫组化法检测囊壁残留卵巢组织AMH表达水平。随访6个月,比较两组病人卵巢储备功能变化。结果两组病人术前血清FSH、E2、FSH/LH及AMH水平差异均无统计学意义(P>0.05)。研究组手术时间、术中出血量均低于对照组,差异有统计学意义(t=4.598、8.124,P<0.05)。研究组标本囊壁卵泡残留比例、AMH表达阳性率均低于对照组,差异有统计学意义(χ~2=10.56、11.25,P<0.05)。术后6个月研究组血清AMH水平高于对照组(t=4.523,P<0.05)。结论术前使用亮丙瑞林2个周期对行腹腔镜卵巢EMs囊肿剔除术病人的卵巢储备功能有一定的保护作用。

Objective To investigate the effect of preoperative application of gonadotropin-releasing hormone agonist(GnRH-a),leuprorelin,on ovarian function in patients undergoing laparoscopic ovarian endometriosis cyst removal.Methods A total of 180 patients who underwent laparoscopic ovarian endometriosis cyst removal were enrolled and randomly divided into study group and control group,with 90 patients in each group.The patients in the study group were given two cycles of leuprorelin before removal,and those in the control group underwent surgery alone;no leuprorelin treatment was given after surgery.Serum levels of follicle-stimulating hormone(FSH),estradiol(E2),FSH/luteinizing hormone(LH),and anti-mullerian hormone(AMH)were measured before surgery,intraoperative conditions and residual follicles on the cyst wall were recorded,and immunohistochemistry was used to measure the expression of AMH in the residual ovarian tissue on the cyst wall.The patients were followed up for6months,and the change in ovarian reserve function was compared between the two groups.Results There were no significant differences in the serum levels of FSH,E2,FSH/LH,and AMH between the two groups before surgery(P>0.05).The study group had a significantly shorter time of operation and a significantly lower intraoperative blood loss than the control group(t=4.598and8.124,P<0.05).Compared with the control group,the study group had significantly lower rate of residual follicles on the cyst wall and positive rate of AMH in samples(χ^2=10.56and11.25,P<0.05).At6months after surgery,the study group had a significantly higher serum level of AMH than the control group(t=4.523,P<0.05).ConclusionPreoperative application of leuprorelin for2cycles has a certain protective effect on ovarian reserve function in patients undergoing laparoscopic ovarian endometriosis cyst removal.