腹腔镜下卵巢巧克力囊肿剥除术对卵巢功能及助孕结局的影响

Influence of laparoscopic ovarian chocolate cyst removal surgery on the ovarian function and the outcome of assisted reproduction

目的对不同分组的不孕患者进行腹腔镜下卵巢巧克力囊肿剥除术或输卵管疏通术及术后的体外受精-胚胎移植(IVF-ET)治疗,探究腹腔镜下卵巢巧克力囊肿剥除术对卵巢功能及助孕结局的影响。方法选取2010年1月至2015年1月上海崇明第三人民医院妇科诊治的32例不孕患者的临床资料进行回顾性分析。挑选其中行腹腔镜下卵巢巧克力囊肿剥除术的22例患者设为实验组,其中单侧卵巢巧克力囊肿11例患者(A组),双侧卵巢巧克力囊肿11例患者(B组),再选择同期单纯输卵管阻塞且无积水的10例患者(C组)设为对照组。所有患者分别行腹腔镜下卵巢巧克力囊肿剥除术或输卵管疏通术,并均以电凝止血为主,术后再行体外受精-胚胎移植(IVF-ET)治疗。所有患者于术前、术后1个月、术后6个月、术后12个月时月经第3天测量血清中FSH、LH、E 2、AMH、INHB浓度值,并用超声仪器检测卵巢体积和卵泡数量等。同时,检测各组患者IVF-ET术前、术中、术后妊娠相关内分泌激素水平和妊娠结局并进行比较分析。结果B组患者术后1个月、6个月、12个月与术前的卵巢储备功能变化情况:患者的FSH、LH水平在囊肿剥除后1个月出现短暂升高,与术前的激素水平相比差异均具有统计学意义(均P<0.05);而E 2、AMH、INHB、AFC水平出现降低,与术前状态相比,其差异均具有统计学意义(均P<0.05);而在术后6个月和12个月时,FSH、LH水平又渐渐降低,E 2、AMH、INHB、AFC水平逐渐升高,术后12个月时的最终浓度与术前无明显变化(P>0.05)。A组患者术后1个月、6个月、12个月与术前的卵巢储备功能变化情况:患者E2在术后1个月时有较为显著的下降,与术前水平相比较,差异具有统计学意义(P<0.05);而在术后6个月、12个月后其浓度又逐渐上升,与术前浓度相比较,差异不具有统计学意义(P>0.05)。腹腔镜下卵巢巧克力囊肿剥除术组患者的内分泌水平及助孕结局比较情况:术前A组、B组患者与对照组患者的基础FSH浓度比较,对照组浓度较低,其差异均具有统计学意义(均P<0.05);三组患者的Gn用量比较,对照组比其他两组用量较少,其差异均具有统计学意义(均P<0.05);同时对照组患者HCG日E 2浓度比B组患者的浓度高,其差异具有统计学意义(P<0.05);对照组的平均获卵数多于B组患者,其差异具有统计学意义(P<0.05);三组患者的临床妊娠率分别为:39.3%、37.6%、40.0%,其差异均无统计学意义(均P>0.05)。结论腹腔镜下A组和B组患者在术后1个月时对卵巢储备功能有一定影响,而6个月至12个月后则恢复术前水平。腹腔镜下卵巢巧克力囊肿剥除术对体外受精-胚胎移植术的临床妊娠率不具有显著影响。

Objective To investigate the effect of laparoscopic ovarian chocolate cyst removal surgery on the ovarian function and the outcome of in vitro fertilization-embryo transfer(IVF-ET).Methods The clinical data of 32 infertility patients in the Chongming 3 rd People′s Hospital of Shanghai from January 2010 to January 2015 was retrospectively analyzed.The 22 patients underwent laparoscopic ovarian chocolate cyst removal surgery were selected as experimental group,including 11 cases with unilateral ovarian chocolate cyst(group A)and 11 cases with bilateral ovarian chocolate cyst(group B).Another 10 patients with oviduct obstruction and without dropsy in the same period were selected as control group(group C).All the patients underwent the laparoscopic ovarian chocolate cyst removal surgery or tubal dredge surgery and performed IVF-ET.The serum FSH,LH,E 2,AMH,INHB level on the 3 rd day of menstrual period before surgery,a month,6 months and 12 months after surgery was detected and the ovary volume and follicle amount was detected by type-B ultrasonic.The hormone levels before,within and after the IVF-ET were detected and compared,and the pregnant outcome was also compared.Results The FSH and LH levels of bilateral ovarian cyst patients in group B experienced a temporary increase and the E 2,AMH,INHB and AFC levels decreased within a month after surgery,with statistically significant differences compared with those before surgery(all P<0.05);but the FSH and LH levels gradually decreased and the E 2,AMH,INHB,AFC levels gradually increased at 6 months and 12 months after surgery,with no statistically significant differences between 12 months after surgery and before surgery(P>0.05).The E 2 level of patients in group A experienced a temporary decrease within a month after surgery,with statistically significant difference compared with that before surgery(P<0.05),but the E 2 level increased gradually later,with no statistically significant differences between 6 months and 12 months after surgery and before surgery(P>0.05).The bFSH level of group A,group B was higher than that of control group,with statistically significant difference(all P<0.05);the Gn dosage of control group was lower than the other two groups,with statistically significant difference(all P<0.05);the E 2 level at HCG day in the control group was higher than that in group B,with statistically significant difference(P<0.05);the average number of eggs obtained in the control group was larger than that of group B,with statistically significant difference(P<0.05);the pregnant rate in the three groups was 39.3%,37.6%and 40.0%respectively,without statistically significant difference(all P>0.05).Conclusions The laparoscopic ovarian chocolate cyst removal surgery has certain effect on the ovarian reserve function of patients in group A and group B at 1 month after surgery,but the function returns to normal level at 6 months or 12 months later.Besides,the surgery has no significant effect on the pregnancy rate of IVF-ET.