腹腔镜下卵巢子宫内膜异位囊肿剥除术后联合GnRH-a治疗对卵巢储备功能及妊娠结局、术后复发的影响

目的:探讨腹腔镜下双侧卵巢子宫内膜异位囊肿剥除术后联合GnRH治疗对卵巢储备功能及生育可能的影响。方法:采用前瞻性对照研究,实验组:双侧卵巢子宫内膜异位囊肿行腹腔镜囊肿剥除术后联合GnRH-a治疗3个月的患者63例。对照组:双侧卵巢子宫内膜异位囊肿行腹腔镜囊肿剥除术的患者62例。比较两组手术前、手术后3月或月经第2～3 d、术后6月月经第2～3 d血清卵泡刺激素(FSH),卵泡刺激素(FSH)/黄体生成激素(LH),雌二醇(E2)的变化,并随访术后18个月自然妊娠及囊肿复发情况。结果:与术前相比,实验组术后3个月FSH较术前明显降低(P<0.05),LH明显减低(P<0.05),E2明显减低(P<0.05)。对照组术后3个月FSH较术前明显增高(P<0.05),LH明显增高(P<0.05),E2明显减低(P<0.05)。实验组患者术后6个月基础FSH恢复至正常范围内占95.3%,而对照组患者基础FSH恢复至正常范围内仅占82.2%,差异有统计学意义(P<0.05)。实验组术前不孕患者术后自然妊娠率57.1%明显高于对照组术前不孕患者术后自然妊娠率36.8%,差异有统计学意义(P<0.05)。实验组术后复发率12.7%明显低于对照组27.4%,差异有统计学意义(P<0.05)。结论:腹腔镜卵巢子宫内膜异位囊肿剥除术对卵巢储备功能有一定的影响,但术后联合GnRH-a治疗大部分患者可在术后6个月内恢复;不孕症患者术后联合GnRH-a治疗可明显提高术后妊娠率,但与临床分期及患者年龄相关;术后联合GnRH-a治疗可明显降低术后复发率。

Influence on the Ovarian Reserved Function After Laparoscopic Cystectomy Combined with Gn-RH -a with Ovarian Endometrioma

Objective:To explore the influence on the Ovarian reserved function and the pregnancy outcome and the postoperative recurrence after Laparoscopic cystectomy combined with gonadotropin-releasing hormone(GnRH-a) treatment on the women with ovarian endometrioma.Methods:This cohort study was conducted in 125 women with bilateral ovarian cyst,who underwent laparoscopic cystectomy.63 cases after Laparoscopic cystectomy combined with GnRH-a treatment 3-6months were study group.Other 62 cases after Laparoscopic cystectomy without GnRH-a treatment were control group.Compared serum levels of estradiol(E2),follicle-stimulating hormone(FSH),and luteum hormone(LH) between two groups,as well as follow-up natural pregnancy and postoperative recurrence after 18 months.Results:In the study groups,compared with the pre-operative,the serum level of FSH decreased significantly(P<0.05),while LH decreased significantly(P<0.05),for E2 decreased significantly(P<0.05) 3 month after the operation.In the control groups,compared with the pre-operative,the serum level of FSH increased significantly(P<0.05),while LH increased significantly(P<0.05),for E2 decreased significantly(P<0.05) 3 month after the operation in the study groups.Conclusions:It suggested that ovarian reserve function would be decreased in laparoscopic bilateral ovarian endometrisis,However,the most patients can recovery in 6 months after the operation by after Laparoscopic operation combined with GnRH-a treatment.The rate of natural pregnancy increased and the rate of postoperative recurrence decreased after the operation.