经阴道注水腹腔镜下卵巢打孔术治疗多囊卵巢综合征不孕

对于多囊卵巢综合征（PCOS）排卵障碍性不孕的首选治疗方案是应用枸橼酸氯米芬促排卵治疗，而对枸橼酸氯米芬抵抗的PCOS患者，常施行经腹腹腔镜下卵巢打孔术。但该手术费用较高、需要住院和全身麻醉。为探索一种更经济、更微创的手术治疗方法，我院自2005年5月起，对10例枸橼酸氯米芬抵抗的PCOS不孕患者施行了经阴道注水腹腔镜下卵巢打孔术（transvaginalhydrolaparoscopicovariandrilling，THLOD），术中同时行宫腔镜检查，效果满意，报道如下。[第一段]     

腹腔镜治疗难治性多囊卵巢综合征不孕患者38例临床分析

目的:探讨腹腔镜对难治性多囊卵巢综合征(PCOS)不孕的治疗效果。方法:2001年3月至2005年5月对我院诊治的38例难治性PCOS不孕症患者,行腹腔镜下卵巢多点打孔术及盆腔粘连松解、输卵管整形术。手术前后分别测血清黄体生成素(LH)、卵泡刺激素(FSH)、雄激素(T)及雌二醇(E2)水平;术后监测排卵情况、妊娠率及妊娠结果。结果:术后血LH和T水平较术前有显著性下降(P<0.01)。术后排卵率81.6%(31/38),1年内累计妊娠18例,妊娠率为47.3%(18/38),早期流产率为16.7%(3/18)。有4例术后3个月内予氯米芬(CC)1~2个疗程后恢复月经外,其余月经情况(经量及持续时间)较术前均有明显改善。结论:腹腔镜卵巢多点打孔术能明显改善难治性PCOS患者的排卵和受孕机会,相对于单纯促排卵药物治疗具有术后排卵率高、妊娠率高、流产率低的优点,尤其对难治性PCOS不孕患者不失为一个有效治疗手段。     

腹腔镜卵巢电凝打孔术治疗难治性多囊卵巢综合征效果评价

多囊卵巢综合征(PCOS)是生育年龄妇女常见的一种复杂的内分泌及代谢异常性疾病,以雄激素过多和持续性无排卵为临床主要特点[1]。1935年由Stein和Leventhal首先报道,故又称Stein-Leventhal综合征[2]。PCOS是导致妇女不孕的主要因素之一。据报道,生育年龄妇女PCOS发病率约为5%～1     

腹腔镜下卵巢打孔术治疗多囊卵巢综合征合并不孕68例临床观察

目的:探讨腹腔镜下卵巢打孔术对多囊卵巢综合征(PCOS)合并不孕的治疗价值。方法:回顾性分析在我院行腹腔镜下双侧卵巢打孔术的68例PCOS合并不孕患者的临床资料和治疗效果。检测手术前后血清促卵泡生成素(FSH)、黄体生成素(LH)、睾酮(T)、雌二醇(E2)水平并进行对比分析,观察术后排卵情况及妊娠率。结果:术后1个月血清LH、LH/FSH、T显著下降(P<0.05)。术后自然排卵率82.4%(56/68),术后妊娠率77.9%(53/68)。结论:腹腔镜下卵巢打孔术是PCOS合并不孕有效的治疗方法,创伤小、出血少、术后恢复快、并发症少。     

多囊卵巢综合征的预后与管理

多囊卵巢综合征 (ＰＣＯＳ)虽其确切病因不清 ,但高雄激素、高胰岛素血症以及胰岛素抵抗和无排卵等临床表现为ＰＣＯＳ的重要特征已成为共识。针对这些特征而采取的治疗方法也不断丰富、完善。由此而引起的ＰＣＯＳ的预后及管理问题目前逐渐引起许多学者的关注。1　克罗米芬促排卵的预后问题目前克罗米芬仍为ＰＣＯＳ患者促排卵的首选药物。克罗米芬可与内源性雌二醇 (Ｅ2 )竞争雌激素受体 ,解除雌二醇对丘脑下部的负反馈抑制 ,最终达到刺激卵泡发育的目的。但应用克罗米芬应注意以下几个问题。适应证 :①无排卵或稀发排卵导致不孕 ,血泌乳…     

多囊卵巢综合征手术治疗的利与弊

多囊卵巢综合征是育龄期妇女最常见的一种内分泌紊乱性疾病,排卵障碍是该类患者不育的主要原因,常用解决方法为促排卵治疗。促排卵药物,例如氯米芬临床效果好,普遍采用。但是,部分患者耐药。手术治疗,特别是腹腔镜下卵巢打孔术是目前用于氯米芬耐药的多囊卵巢综合征患者促排卵治疗的二线治疗方案,本文就卵巢手术的主要方式、腹腔镜下卵巢打孔术的适应人群、术后效果及手术并发症进行简单概括。     

二甲双胍改善多囊卵巢综合征患者应用克罗米芬促排卵效果的观察

目前，越来越多的研究表明，多囊卵巢综合征(PCOS)患者无论肥胖与否，都存在不同程度的胰岛素抵抗及高胰岛素血症，而且胰岛素水平与雄激素水平呈正相关。应用胰岛素增敏剂可降低外周血胰岛素水平，同时也可降低雄性激素水平，并改善PCOS患者的排卵情况。二甲双胍是治疗2型糖尿病，增加胰岛素敏感性的药物，本研究观察了对于克     

克罗米芬联合尿促性素对多囊卵巢综合征患者促排卵的临床效果

目的 探究多囊卵巢综合征（PCOS）患者采取克罗米芬联合尿促性素治疗对其促排卵的临床效果。方法 选取80例PCOS患者,采取随机数字表法分为对照组与试验组,每组40例。对照组采用克罗米芬治疗,试验组采用克罗米芬联合尿促性素治疗。比较两组促排卵效果、排卵率及妊娠率。结果 治疗前,两组患者排卵数、优势卵泡数、优势卵泡平均直径及卵泡成熟日比较,差异无统计学意义（P>0.05）。治疗后,两组患者排卵数、优势卵泡数均多于治疗前,卵泡成熟日短于治疗前,差异有统计学意义（P<0.05）,优势卵泡平均直径治疗前、治疗后比较,差异无统计学意义（P>0.05）。治疗后,试验组排卵数、优势卵泡数均多于对照组,差异有统计学意义（P<0.05）,试验组优势卵泡平均直径、卵泡成熟日与对照组比较,差异无统计学意义（P>0.05）。试验组患者排卵率82.50%、妊娠率55.00%均高于对照组的60.00%、32.50%,差异有统计学意义（P<0.05）。结论 克罗米芬联合尿促性素治疗PCOS患者可提高患者促排卵效果,提升排卵率及妊娠率,临床应用价值高。     

腹腔镜术结合中医治疗多囊卵巢综合征

目的:腹腔镜术结合中医治疗多囊卵巢综合征的临床效果。方法:50例中医辨证为痰湿阻滞型多囊卵巢综合征不育患者,随机分成二组:手术+中医治疗组(研究组)30例,采用化痰补肾法结合腹腔镜下卵巢契形切除术治疗;对照组20例采用单纯腹腔镜下卵巢契形切除术治疗,观察比较二组的临床治疗效果。结果:研究组总有效率为96.7%,妊娠率达90.0%;对照组总有效率75.0%,妊娠率45.0%,二组疗效比较,差异有统计学意义(P<0.05)。结论:腹腔镜下手术结合中医治疗多囊卵巢综合征疗效显著,妊娠率高,具有较好的实用价值和推广价值。     

多囊卵巢综合征患者用克罗米酚促排卵结局与相关因 …

目的 探讨在多囊卵巢综合征（ＰＣＯＳ）患者中影响克罗米酚（ＣＣ）促排卵因素。方法 对９４例因多囊卵巢综合征不孕患者,用ＣＣ促排卵治疗。采用放射免疫方法测定卵泡刺激素（ＦＳＨ）,黄体生成素（ＬＨ）,雌二醇（Ｅ２）、睾酮（Ｔ）,雄烯二酮（Ａ）,泌乳素（ＰＲＬ）水平及胰岛素释放反应。分析了卵结局与年龄,基础激素水平、胰岛素抵抗（ＩＲ）、胰岛素反应曲线下面积（ＡＵＣ１）及体重指数（ＢＭＩ）之间的关系。结果     

Reproductive outcome after letrozole versus laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome

Objective

To compare the clinical outcomes of letrozole and laparoscopic ovarian drilling (LOD) in patients with clomiphene-citrate-resistant polycystic ovary syndrome (PCOS).

Methods

In the present prospective randomized trial, 140 women with clomiphene-citrate-resistant PCOS were randomly allocated to receive 5 mg letrozole from day 3 to day 7 of menses for 6 consecutive cycles, or to undergo LOD. When a leading follicle of at least 18 mm was present, ovulation was triggered with human chorionic gonadotropin (hCG). The 6-month rates of ovulation, pregnancy, abortion, and live births were evaluated.

Results

The groups were similar with regard to baseline clinical characteristics and hormonal profiles. The ovulation rate was significantly higher in the letrozole group than in the LOD group (59.0% versus 47.5%). On the days of the hCG injection, women in the letrozole group had a significantly thicker endometrium than those in the LOD group (P < 0.0001). Women receiving letrozole had a higher pregnancy rate (35.7% versus 28.6%) and a lower rate of spontaneous abortion (8.0% versus 20.0%, respectively), but these differences were not statistically significant.

Conclusion

Letrozole seems to be a suitable second-line ovulation-inducing alternative to LOD in women with PCOS who do not conceive with clomiphene citrate.     

腹腔镜电凝打孔治疗多囊卵巢综合征的远期疗效分析

目的 :观察腹腔镜电凝打孔治疗多囊卵巢综合征 (PCOS)的远期疗效。方法 :于 1997年 7月～ 2 0 0 3年 9月对克罗米酚促排卵治疗无效的PCOS患者 5 0例 ,行腹腔镜电凝打孔术 ,观察手术前后FSH、LH、T、E2 、PRL、LH/FSH的变化。并对比手术前后卵巢体积及形态的变化。术后根据基础体温测定 (BBT)及B超监测排卵并随访受孕情况。结果 :随访时间 3～ 73月 ,其中 6 0月以上 15例。术后LH、T、LH/FSH较术前明显降低 (P <0 .0 1) ,卵巢体积由术前平均 11cm3变为术后平均 8.4cm3,月经情况明显改善 ,该方法治疗PCOS自然恢复排卵率 94 % ,术后 5年累积受孕率 76 % ,无并发症发生。结论 :腹腔镜治疗PCOS简单易行、创伤小、恢复快 ,远期疗效好 ,为难治的PCOS患者提供了新的治疗途径     

Metformin versus laparoscopic ovarian drilling in clomiphene- and insulin-resistant women with polycystic ovary syndrome

Objective

To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling.

Methods

A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n = 55) or laparoscopic ovarian drilling (group 2, n = 55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The χ² test was used for comparisons of ovulation, pregnancy, and abortion rates.

Results

Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P < 0.001 vs P < 0.001), and luteinizing hormone (P < 0.05 vs P < 0.001), while the glucose to insulin ratio was significantly increased (P < 0.001 vs P < 0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P < 0.04; 50.8% [131/258] vs 33.5% [94/281], P < 0.001; and 38.2% [21/55] vs 20.0% [11/55], P < 0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant.

Conclusion

Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy.     

Clomiphene citrate plus tamoxifen versus laparoscopic ovarian drilling in women with clomiphene-resistant polycystic ovary syndrome

Objective

To compare the efficacy of clomiphene citrate (CC) plus tamoxifen with that of laparoscopic ovarian drilling in clomiphene-resistant women with polycystic ovary syndrome (PCOS).

Method

We randomly allocated 150 women with CC-resistant PCOS to a combined medication group (group 1) or a laparoscopic surgery group (group 2). The primary outcome was the live birth rate in each group; secondary outcomes were the rates of ovulation, clinical pregnancy and miscarriage.

Results

There were no significant differences between the groups regarding rates of ovulation (81.3% vs 85.3%), pregnancy (53.3% vs 50.7%), or live births (49.3% vs 44.0%), but the mean endometrium thickness was significantly greater on the day of human chorionic gonadotropin administration in group 1 (P < 0.001).

Conclusion

Clomiphene citrate plus tamoxifen was as effective as laparoscopic ovarian drilling in promoting ovulation and pregnancy.     

Changes in ovarian reserve and ovarian blood flow in patients with polycystic ovary syndrome following laparoscopic ovarian drilling

This prospective cohort study was conducted on 80 patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome undergoing laparoscopic ovarian drilling (LOD). Pre- and post-LOD ovarian reserve parameters (anti-Mullerian hormone: AMH, ovarian volume: OV, and antral follicle count: AFC) and ovarian stromal blood flow indices (Vascularization index: VI, flow index: FI, and vascularization flow index: VFI) were measured to explore the effect of LOD and to find out the correlation between serum AMH and different clinical, hormonal, and ultrasonic variables. There was a highly significant reduction of the serum AMH (p?p?相似文献   

难治性多囊卵巢综合征的治疗策略及结局

目的 探讨对持续无排卵的多囊卵巢综合征（ＰＣＯＳ）患者使用诱发排卵的治疗方案及其治疗效果。方法 收集氯米芬抵抗的ＰＣＯＳ患者５９例,共８１个治疗周期,分为３组：（１）促卵泡激素（ＦＳＨ）组,４９个治疗周期;（２）ＦＳＨ＋促性腺激素释放激素（ＧｎＲＨ）泵组,１３个周期;（３）常规体外受精（ＩＶＦ）组,１９个周期。前两组给予前期降黄体生成素（ＬＨ）及睾酮（Ｔ）治疗。观察用促排或超排治疗后雌二醇（Ｅ２）     

Efficacy of laparoscopic ovarian drilling for polycystic ovary syndrome resistant to clomiphene citrate

AIM: It is difficult to induce ovulation in patients with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC) because of the narrow safety margin of human menopausal gonadotropin preparations. In the present study, patients diagnosed as having PCOS according to the Japanese diagnostic criteria were divided into two groups (Groups H and N). Testosterone level was used as a cut-off value between Groups H and N to examine the usefulness of laparoscopic ovarian drilling (LOD) to induce ovulation. METHODS: Thirty-two women with PCOS resistant to CC who underwent LOD were evaluated. The patients were divided into a high and a normal androgen group (Groups H and N with 19 and 13 patients, respectively) based on the level of testosterone measured 1 week before surgery using a cut-off value of 50 ng/dL. LOD was performed with microlaparoscopy under intravenous anesthesia. RESULTS: After LOD, spontaneous ovulation occurred in 16 (84.2%) and nine (69.2%) patients in Groups H and N, respectively. Additional treatment with CC was given to 12 (63.2%) and 11 (84.6%) patients, respectively. No significant difference was noted with regard to the spontaneous ovulation rate after LOD. Eighteen pregnancies were established in 17 patients (53.1%). The pregnancy rate after LOD was not significantly different between Groups H and N: 42.1% (8 patients) and 76.9% (10 patients), respectively. CONCLUSION: Patients with PCOS as diagnosed based on the Japanese diagnostic criteria include those with increased and normal androgen levels. LOD is considered an effective ovulation induction method for both types of patients with PCOS.     

Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian drilling

Objective. To evaluate ovarian reserve assessed by hormones and sonography in women with polycystic ovary syndrome (PCOS) undergoing laparoscopic ovarian drilling (LOD).

Methods. This was a cross-sectional study. Twenty-one PCOS women undergoing LOD were enrolled in the study (the LOD group). Their day-3 anti-Müllerian hormone (AMH), inhibin B, follicle-stimulating hormone (FSH) levels, antral follicles count (AFC) and summed ovarian volume representing ovarian reserve were compared with those of PCOS women who did not undergo LOD (the PCOS group) and those of normal ovulatory women (the control group).

Results. There were no differences in age and body mass index between groups. AMH levels seemed to be lower in the LOD (4.60 ± 3.16 ng/ml) than in the PCOS (5.99 ± 3.36 ng/ml) groups, but did not reach statistical significance. Day-3 FSH levels were significantly higher and AFC was significantly lower in the LOD than in the PCOS group. AMH levels, AFC and summed ovarian volume were significantly greater, but FSH was significantly lower, in the PCOS group compared with the control group. There were no differences in inhibin B levels between groups.

Conclusion. This study showed that ovarian reserve assessed by hormonal levels and sonography seems to be lower in the LOD than in the PCOS group. The PCOS women both with and without LOD had significantly greater ovarian reserve than the age-matched controls having normal ovulatory menstruation.