多囊卵巢综合征患者卵巢打孔后影响自然妊娠相关因素分析

目的探讨影响腹腔镜卵巢打孔治疗多囊卵巢综合征（PCOS）不孕患者自然妊娠的相关因素。方法以腹腔镜卵巢打孔治疗PCOS后自然妊娠患者168例为妊娠组,未能自然妊娠患者82例为未妊娠组,对比分析两组患者一般情况、打孔数目、术后并发盆腔粘连、患者卵巢储备功能及激素分泌情况。结果妊娠组BMI≥23 kg/m^2者所占比例（48.2%）显著低于未妊娠组（68.3%）（χ^2=8.968,P〈0.01）。两组打孔数目相比无显著差异（3.2±1.6 vs 3.5±1.8）（t=1.3351,P〉0.05）。妊娠组术后并发盆腔粘连（1.8%）较非妊娠组（9.8%）显著降低（χ^2=8.3221,P〈0.01）。妊娠组术后卵巢体积（OV）、窦卵泡数（AFC）、基础黄体生成素（LH）、卵泡雌激素（FSH）、雌二醇（E2）及性激素结合球蛋白（SHBG）均显著高于非妊娠组（P〈0.05或P〈0.01）,基础睾酮（T）、雄激素游离指数（FAI）、稳态胰岛素评价指数（HOMA-IR）均较非妊娠组显著降低（P〈0.01）。结论 BMI、卵巢储备功能、高雄激素血症及胰岛素抵抗与PCOS患者卵巢打孔治疗后自然妊娠相关。

Analysis of correlation factors of natural pregnancy for patients with polycystic ovary syndrome after laparoscopic ovarian drilling

Objective To explore the factors correlated with natural pregnancy of patients with polycystic ovary syndrome（PCOS）after laparoscopic ovarian drilling（LOD）.Methods Total 168 pregnant patients with PCOS after LOD treatment were considered as the pregnancy group,and 82 non-pregnant patients were considered as the non-pregnancy group.The general conditions,amount of drillings,complicated pelvic adhesions after operation,and the reserved ovarian function and hormone secretion level were compared between the 2 groups.Results The ratio of patients whose BMI≥23 kg /m^2 in the pregnancy group（48.2%） was obviously lower than that in the non-pregnancy group（68.3%）（χ^2= 8.968,P〈0.01）.The amounts of drillings had not obvious difference（3.2 ±1.6 vs 3.5 ±1.8）between the 2 groups（t = 1.3351,P〈0.05）;the incidence of the complicated pelvic adhesions in the pregnancy group（1.8%）was obviously lower than that in the non-pregnancy group（9.8%,χ^2= 8.3221,P〈0.01）;OV,AFC,basal levels of LH,FSH,E2 and SHBG of patients in the pregnancy group were obviously higher than those in the non-pregnancy group（P〈0.05 or P〈0.01）;and T,FAI and HOMA-IR of patients in the pregnancy group were obviously lower than those in the non-pregnancy group（P〈0.01）.Conclusion The BMI,reserved ovarian function,hyper-androgenemia（HA） and insulin resistance are related to natural pregnancy of patients with POCS after laparoscopic ovarian drilling.