腹腔镜卵巢打孔对PCOS耐氯米芬患者的疗效研究

目的:观察腹腔镜手术治疗耐氯米芬(CC)多囊卵巢综合征(PCOS)不孕患者疗效的影响因素。方法:对46例耐氯米芬的PCOS患者行腹腔镜卵巢打孔术,按术后6周内是否恢复排卵分有效组(排卵)和无效组(无排卵)。分析两组间患者的年龄、不孕年限、体重指数(BMI)、性激素水平对临床疗效的影响。结果:术后有38例患者发生排卵,26例成功妊娠;8例即使在加用CC后仍无排卵与妊娠。有效组术前患者血清LH、LH/FSH的水平明显比无效组高,而不孕年限、BMI明显比无效组低;术后血清LH、LH/FSH及T水平明显下降,FSH及PRL水平无明显变化。无效组手术前后患者血清LH、LH/FSH水平无明显变化,术后血清FSH及PRL水平有上升的趋势。结论:对耐氯米芬PCOS患者行腹腔镜治疗时,术前患者不孕年限、BMI、LH、LH/FSH水平及术后LH、LH/FSH及T水平的下降幅度是预测术后排卵有效的指标,同时应该全面考虑患者的FSH、PRL水平的变化。

Predictors for Ovulation after Laparoscopic Ovarian Drilling in Polycystic Ovary Syndrome Women with Clomiphene Citrate Resistant

Objective:To analyze preoperative and postoperative factors affecting the efficacy of laparoscopic ovarian drilling (LOD) for inducing ovulation in clomiphene citrate (CC)-resistant PCOS patients.Methods:46 infertile women with CC-resistant PCOS received LOD.The influence of the various preoperative and postoperative characteristics on the ovulation rates after LOD was evaluated.The ovulation rates were compared between the categories of each factor.Results:After LOD,ovulation occurred in 38 patients;pregnancy occurred in 26 patients;and anovulation occurred in 8 patients after LOD,even followed by CC treatment.Preoperative serum luteinizing hormone (LH) levels and the LH/ follicle-stimulating hormone (FSH) ratio were significantly higher in the ovulating group than in the non-ovulating group.PCOS women with elevated body mass index (BMI) and longer infertile duration seemed to poorly respond to LOD.Postoperative serum LH and T levels and the LH/FSH ratio significantly dropped in ovulating group,but unchanged in the non-ovulating group which conversely with increasing tendency of serum FSH and Prolactin levels.Conclusions:Preoperative serum LH levels,BMI and duration of infertility may be good predictors of LOD efficacy in patients with PCOS,while as the extent of decrease serum LH levels,the LH/FSH ratio and T levels after LOD.