两种手术方式治疗卵巢子宫内膜异位囊肿效果及对卵巢储备功能影响

Effect of two different surgical methods for treating patients with ovarian endometriosis cysts and their influences on the ovarian reserve function of the patients

目的:探究腹腔镜直接囊肿剥除术与超声引导下穿刺术治疗卵巢子宫内膜异位囊肿(EIC)效果及对卵巢储备功能影响。方法:回顾性收集2018年6月-2020年3月本院行腹腔镜直接囊肿剥除术或经阴道超声引导下穿刺术的EIC患者临床资料97例,根据不同手术方式分为腔镜剥除组(n=57)和超声穿刺组(n=40)。比较两组术前及术后3、6个月血清促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)、抗缪勒管激素(AMH)水平、窦卵泡计数(AFC)及卵巢体积,分析术后1年内患者月经周期、月经量、自然受孕、优质胚胎、自然流产、不良妊娠及复发率。结果:术后3个月腔镜剥除组血清FSH(12.35±2.01U/L)、LH(9.85±1.66U/L)高于术前(7.16±1.63U/L、6.55±2.19U/L),E2(81.82±18.29pg/ml)低于术前(113.36±116.1pg/ml),与超声穿刺组(8.02±1.18U/L、6.98±1.17U/L、111.25±15.35pg/ml)均有差异(均P<0.05),而超声穿刺组手术前后无差异(P>0.05);AMH水平,术后3个月两组均低于术前但超声穿刺组(3.16±0.15ng/ml)高于腔镜剥除组(2.35±0.11ng/ml),术后6个月超声穿刺组(3.22±0.22ng/ml)低于腔镜剥除组(3.63±0.16ng/ml)(均P<0.05);AFC,术后3个月腔镜剥除组(6.37±1.26个)和超声穿刺组(6.97±0.98个)均低于术前(8.52±1.09个、8.53±1.21个)(均P<0.05);卵巢体积,腔镜剥除组和超声穿刺组术后3个月(4.55±1.11cm2、4.82±1.09cm2)、术后6月(4.21±1.32cm2、4.68±1.26cm2)均小于术前(6.63±1.25cm2、6.28±1.52cm2)(均P<0.05);术后3个月,月经周期腔镜剥除组(33.41±12.87d)长于超声穿刺组(28.89±7.23d),自然受孕率腔镜剥除组(56.1%)高于超声穿刺组(35.0%),复发率腔镜剥除组(5.3%)低于超声穿刺组(20.0%)(均P<0.05),优质胚胎、自然流产及不良妊娠两组无差异(P>0.05)。结论:腹腔镜直接囊肿剥除术对卵巢储备功能造成的损伤更大,但受孕率比经阴道超声引导下穿刺术高。针对年轻且生育需求强烈的育龄女性,适合采取腹腔镜直接囊肿剥除术,对于年龄超过35岁且卵巢功能低下患者,超声引导下穿刺术可发挥更好优势。

Objective:To explore the effect of laparoscopic cystectomy and ultrasound guided puncture surgery for treating patients with ovarian endometriotic cysts(EIC),and to study the ovarian reserve function of the patients.Methods:A retrospective analysis was conducted on the clinical data of 97patients with EIC who had undergone laparoscopic cystectomy or transvaginal ultrasound guided puncture surgery between June 2018and March 2020.These patients were divided into 57cases with laparoscopic cystectomy in group A and 40cases with ultrasound puncture in group B according to different surgical methods.The levels of serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Mullerian hormone(AMH),the antral follicle count(AFC),and the ovarian volume of the patients before surgery and at 3and 6 months after surgery were compared between the two groups.The menstrual cycle,the menstrual volume,the natural pregnancy,the high-quality embryos,the spontaneous abortion,and the recurrence of EIC of the patients within 1year after surgery were statistically analyzed.Results:3months after surgery,the levels of serum FSH(12.35±2.01IU/L)and LH(9.85±1.66IU/L)of the patients in group A were significantly higher than those(7.16±1.63IU/L and 6.55±2.19IU/L)before surgery,the E2level(81.82±18.29pg/ml)was significantly lower than that(113.36±116.1pg/ml)before operation,and all of which had significantly different from those(8.02±1.18IU/L,6.98±1.17IU/L,and 111.25±15.35pg/ml)of the patients in group B(all P<0.05),while which of the patients in group B had no significantly different between before and after surgery(P>0.05).The level of AMH of the patients in both groupsP!in the 3rd month after surgery was significantly lower than that before surgery,but which(3.16±0.15ng/ml)of the patients in group B was significantly higher than that(2.35±0.11ng/ml)of the patients in group A.In the 6th month after surgery,the level of AMH(3.22±0.22ng/ml)of the patients in group B was significantly lower than that(3.63±0.16ng/ml)of the patients in group A(P<0.05).The AFC of the patients in group A(6.37±1.26)and in group B(6.97±0.98)of the patients in the 3rd month after surgery were significantly lower than those(8.52±1.09and 8.53±1.21)before surgery(all P<0.05).The ovarian volume of the patients in both group in the postoperative 3rd month(4.55±1.11cm2 and 4.82±1.09cm2)and in the postoperative 6th month(4.21±1.32cm2 and 4.68±1.26cm2)were significantly less than those(6.63±1.25cm2 and 6.28±1.52cm2)before surgery(all P<0.05).In the 3rd months after surgery,the menstrual cycle(33.41±12.87d)of the patients in group A was significantly longer than that(28.89±7.23d)of the patients in group B.The natural pregnancy rate(56.1%)of the patients in group A was significantly higher than that(35.0%)of the patients in group B,and the recurrence rate(5.3%)of the patients in group A was significantly higher than that(20.0%)of the patients in group B(all P<0.05).There were no significant differences in the rates of high-quality embryo,spontaneous abortion,and adverse pregnancy of the patients between the two groups(P>0.05).Conclusion:Laparoscopic cystectomy for treating EIC of the patients has greater damage to their ovarian reserve function,but the successful pregnancy rate of which is higher than that of transvaginal ultrasound guided puncture for treating EIC.Laparoscopic cystectomy for treating EIC of the patients is more suitable for the young patients of childbearing age with strong fertility needs.For the patients over 35 years old with EIC and fertility needs,transvaginal ultrasound guided puncture for treating the EIC can better show its advantages.