卵巢子宫内膜异位囊肿治疗方式对卵巢功能及妊娠结局的影响

Influence of different treatment of ovarian endometriosis cyst on ovarian function and pregnancy outcomes

目的:研究卵巢囊肿不同治疗方式对卵巢功能及受孕后临床结局的影响。方法:回顾性收集2017年12月-2018年12月本院收治的卵巢囊肿患者100例临床资料,根据手术方式分为腹腔镜剥除术组和B超穿刺组各50例。比较两组手术时间、术中出血量、术后肛门排气时间、术后缓解情况、术后并发症、复发情况以及性激素水平等;随访两组术后1年妊娠情况。利用logistic回归分析发生自然流产的相关因素。结果:腹腔镜剥除术组手术时间(49.7±3.8 min)、术中出血量(133.8±11.1 ml)及术后肛门排气时间(23.3±2.3 h)均高于B超穿刺组,术后缓解率(92.0%)高于B超穿刺组(64.0%),并发症发生率(22.0%)和术后复发率(16.0%)高于B超穿刺组,性激素水平高于B超穿刺组,窦卵泡数(6.5±1.8个)低于B超穿刺组(均P<0.05)。两组术后受孕和不良妊娠比例无差异(P>0.05);腹腔镜剥除术组优质胚胎比例低于B超穿刺组,而自然流产率高于B超穿刺组(均P<0.05)。回归分析显示性激素水平、窦卵泡数、手术方式是自然流产的相关因素。结论:相比腹腔镜剥除术,B超穿刺术对治疗卵巢囊肿缓解率、优质胚胎率较高,自然流产率较低,因此,针对年轻、有迫切生育要求的患者,可采用B超穿刺方法治疗卵巢子宫内膜异位囊肿。

Objective:To study the influence of different treatment of ovarian endometriosis cyst on ovarian function and the clinical pregnancy outcomes.Methods:The clinical data of 100 women with ovarian cyst from December 2017 to December 2018 were retrospectively collected.According to different surgical methods,these women were divided into group A(laparoscopic ablation of ovarian cyst)and group B(50 women with puncture of ovarian cyst monitored by B ultrasound).The operative time,intraoperative blood loss,postoperative anal exhaust time,postoperative remission situation,postoperative complication rate,recurrence rate,and sex hormone levels were compared between the two groups.The pregnancy status of the two groups was followed up for 1 year.Logistic regression was used to analyze the related factors of spontaneous abortion.Results:The operating time,intraoperative blood loss,postoperative anal exhaust time,the complications rate,and postoperative recurrence rate of women in group A were 49.7±3.8 min,133.8±11.1 ml,23.3±2.3h,22.0%,and 16.0%,respectively,which were significant higher than those of women in group B,the postoperative remission rate of women in group A was 92.0%,which was also significant higher than that(64.0%)of women in group B,and the sex hormone levels of women in group A were significant higher,but the sinus follicle numbers of women in group A was 6.5±1.8,which was significant less than that of women in group B(all P<0.05).There were no significant difference in the ratio of postoperative pregnancy and adverse pregnancy between the two groups(P>0.05).The proportion of high-quality embryos of women in group A was significant lower than that of women in group B,while the rate of spontaneous abortion of women in group A was significant higher than that of women in group B(all P<0.05).Regression analysis showed that sex hormone level,number of sinus follicles,and surgical method were the related influence factors of spontaneous abortion.Conclusion:Compared with laparoscopy ablation of ovarian cyst,puncture of ovarian cyst monitored by B ultrasound has a higher remission rate of ovarian cysts,a higher rate of high-quality embryos,and a lower rate of spontaneous abortion.So it is suggested that puncture of ovarian cyst monitored by B ultrasound is priority for treatment of ovarian cyst.