腹腔镜辅以来曲唑治疗难治性多囊卵巢综合征不孕的临床研究

目的:探讨腹腔镜辅以来曲唑治疗难治性多囊卵巢综合征(PCOS)不孕的治疗效果。方法:将2010年1月～2011年12月120例诊断为难治性PCOS的患者随机分为研究组和对照组各60例。研究组采用腹腔镜打孔联合来曲唑促排卵治疗,对照组采用单纯腹腔镜打孔术。在治疗前及治疗后监测患者的基础雌二醇(E2),促卵泡生成激(FSH)、促黄体生成激素(LH)、睾酮(T)以及基础体温(BBT),并利用B超监测卵泡发育和排卵情况。结果:研究组和对照组治疗后较治疗前FSH均明显升高,LH/FSH的比值显著下降,睾酮水平也明显下降(P<0.05)。研究组和对照组患者的E2水平治疗后较治疗前下降(P<0.05),且研究组下降更为显著(P<0.05)。对照组术后进行BBT和B超监测排卵显示排卵率为68.6%,妊娠率为46.7%,而研究组的排卵率为92.9%,妊娠率达98.3%,明显高于对照组(P<0.01)。结论:腹腔镜辅以来曲唑治疗难治性多囊卵巢综合征不孕可以明显降低患者的LH、E2及睾酮的水平,增加FSH水平,有效改善难治性PCOS患者的生殖内环境,提高排卵率和妊娠率,值得在临床推广应用。

Clinical study on laparoscopy combined with letrozole for treatment of infertile patients with refractory polycystic ovary syndrome

Objective:To explore the curative effect of laparoscopy combined with letrozole for treatment of infertile patients with refractory polycystic ovary syndrome(PCOS). Methods:One hundred and twenty patients diagnosed as refractory PCOS from January 2010 to December 2011 were randomly divided into study group and control group,60 patients in each group;the patients in study group were treated with ovulation induction with laparoscopy combined with letrozole,while the patients were treated with simple laparoscopy;the levels of basic estradiol,follicle-stimulating hormone(FSH),luteinizing hormone(LH),and testosterone,basic body temperature(BBT) before and after treatment were monitored;type B ultrasound was used to monitor follicular development and ovulation. Results:In study group and control group,FSH levels after treatment were significantly higher than those before treatment,the ratios of LH/FSH after treatment were significantly lower than those before treatment,the level of testosterone decreased significantly after treatment(P<0.05),the levels of estradiol after treatment were significantly lower than those before treatment(P<0.05),especially in study group(P<0.05).The ovulation rate and pregnancy rate in control group were 68.6% and 46.7%,respectively,while in study group,the ovulation rate and pregnancy rate were 92.9% and 98.3%,respectively,which were statistically significantly higher than those in control group(P<0.01). Conclusion:Laparoscopy combined with letrozole can significantly reduce the levels of LH,estradiol,and testosterone,and increase FSH level of infertile patients with refractory PCOS,effectively improve the reproductive internal environment,and increase ovulation rate and pregnancy rate,which is worthy to be popularized and applied in clinic.