腹腔镜卵巢针刺术治疗多囊卵巢综合征的临床研究

目的：评价腹腔镜卵巢针刺术治疗氯米芬抵抗多囊卵巢综合征（PCOS）的临床疗效。方法：选择2010年1月—2014年3月因不孕症来我院就诊的患者，确诊为PCOS且对氯米芬抵抗患者72例，行腹腔镜下卵巢穿刺术同时进行宫腔镜输卵管导管介入通液术。观察术前及术后黄体生成激素（LH）、卵泡刺激素（FSH）、睾酮（T）、泌乳素（PRL）、雌二醇（E2）的变化，观察术前及术后双侧卵巢体积及形态、排卵情况的变化，随访2年后生育转归情况并进行分析。结果：72例PCOS且对氯米芬抵抗患者行腹腔镜下卵巢针刺术，10例输卵管、卵巢粘连者予以粘连分解术。2例提示一侧输卵管堵塞，经宫腔镜下输卵管导丝介入后通畅。腹腔镜下卵巢针刺术后2个月LH、T水平与术前相比均降低，差异有统计学意义（P＜0.05）。卵巢体积术前平均为（11.773±6.553）cm3，术后2个月平均为（7.852±3.763） cm3，术后卵巢体积缩小（t=2.974，P=0.009）。自然排卵率达61.11%（44/72），加上药物治疗后排卵率可高达86.11%（62/72）。术后24个月妊娠率47.2%（34/72)。结论：腹腔镜卵巢针刺术治疗PCOS操作简单，创伤小，安全性高，疗效满意，为药物治疗失败的PCOS患者提供了新的治疗途径。

Application of Laparoscopic Ovarian Puncture in Treatment of Polycystic Ovary Syndrome

Objective: To evaluate the therapeutic efficacy of laparoscopic ovarian puncture for those patients with clomiphene-resistant polycystic ovary syndrome (PCOS). Methods: Seventy-two women with clomifene-resistant PCOS were treated by laparoscopic ovarian puncture from Jan. 2010 to Mar. 2014. Laparoscopic ovarian paracentesis and hydrotubation were jointly performed. The levels of serum FSH, LH, E2, T and PRL were examined, while the ovarian volume and shape were observed before and after the operation. Postoperative ovulation was monitored by B-type ultrasound, and the pregnancy rate was followed up within 2 years after operation. Results: In 72 women with clomifene-resistant PCOS treated by laparoscopic ovarian puncture, ten cases with peritubal and ovarian adhesion were jointly treated by adhesiolysis. Two patients with unilateral tubal blocked were recanulated by the guidewire under hysteroscopy. The levels of LH and T in postoperative 2-month were significantly lower than those before operation (P<0.05), while the ovarian volume was significantly decreased when compared with that before operation (7.852±3.763 cm3 vs. 11.773±6.553 cm3, t=2.974, P=0.009). The total natural ovulation rate was 61.11% (44/72), and the ovulation rate increased to 86.11%(62/72) when medical therapy was used as well. The cumulated pregnancy rate was 47.2% (34/72) within 24 months after operation. Conclusions: Laparoscopic ovarian puncture is a simple, mini-invasive and safe surgery, which is an alternative treatment for patients with drug-resistant PCOS.