子宫内膜异位患者行腹腔镜卵巢子宫内膜异位囊肿剥除术后卵巢储备功能变化及临床意义

Changes and clinical significance of ovarian reserve function in patients with endometriosis after laparoscopic cystectomy

目的探讨子宫内膜异位(EM)患者行腹腔镜卵巢子宫内膜异位囊肿剥除术后卵巢储备功能变化及临床意义。方法抽取河南黄河科技学院附属医院2019年11月至2020年12月收治的60例行腹腔镜卵巢子宫内膜异位囊肿剥除术的EM患者,分别于术前及术后1、3、6个月测定血清卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)及抗苗勒管激素(AMH)水平,并行窦卵泡计数(AFC)检测。结果术后1个月,患者血清AMH、E2及AFC比术前降低(P<0.05),血清FSH、FSH/LH比术前提高(P<0.05)。术后3个月,患者血清FSH、FSH/LH、E2及AFC水平与术前比较无明显变化(P>0.05),而血清AMH仍低于术前(P<0.05)。术后6个月,患者血清AMH比术前降低(P<0.05),而其他各项指标均基本恢复至术前水平(P>0.05)。患者术后6个月AMH下降率与年龄、囊肿部位有关(P<0.05),而与囊肿类型、囊肿大小、病理类型、r-AFS分期等无关(P>0.05)。结论行腹腔镜卵巢子宫内膜异位囊肿剥除术的EM患者术后6个月仍存在卵巢储备损伤,AMH相较于传统标志物能够更好地反映卵巢储备功能。

Objective To investigate the changes and clinical significance of ovarian reserve function in patients with endometriosis(EM)after laparoscopic cystectomy.Methods Sixty patients with EM treated by laparoscopic cystectomy in the Affiliated Hospital of Huanghe University of Science and Technology from November 2019 to December 2020 were selected.The levels of serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)and anti-Mullerian hormone(AMH)were determined before operation and at 1,3,6 months after operation.The antral follicle count(AFC)was detected.Results Serum AMH,E2 and AFC were decreased at 1 month after operation(P<0.05),while levels of serum FSH and FSH/LH were increased(P<0.05).There were no obvious changes in serum FSH,FSH/LH,E2 or AFC after operation(P>0.05),while serum AMH was significantly lower than that before operation(P<0.05).Serum AMH was decreased at 6 months after operation(P<0.05),while the other indexes were basically restored to preoperative levels(P>0.05).The decline rate of AMH at 6 months after operation was related to age and site of the cyst(P<0.05),but not related to the type,size,pathological type or r-AFS stage of the cyst(P>0.05).Conclusions The patients with EM who underwent laparoscopic ovarian endometriosis cystectomy still had ovarian reserve damage 6 months after operation.AMH can better reflect the ovarian reserve function than traditional markers.