腹腔镜治疗顽固性多囊卵巢综合征电能对卵巢超声影像及内分泌影响的研究

目的:探讨对顽固性多囊卵巢综合征(PCOS)患者行腹腔镜下卵巢电灼术(LOD)时,单侧卵巢所负荷电能对患者术后内分泌及卵巢超声影像学的影响。方法:60例顽固性PCOS患者按其在LOD术中单侧卵巢所负荷电能分成两组,观察术后内分泌变化并测量卵巢卵泡发育期、围排卵期、黄体期卵巢血流。结果:LOD术后,Ⅰ组患者的LH、T、LH/FSH较术前明显下降(P<0.05),Ⅱ组患者的LH、T、LH/FSH较术前有下降趋势,但差异无统计学意义(P>0.05);LOD术后,Ⅰ组患者卵巢干动脉、卵巢基质动脉最大血流速度(S)、舒张期最低血流速度(D)均显著高于Ⅱ组患者术后水平,而阻力指数(R I)则相反(P<0.05),Ⅰ组术后上述指标较正常妇女比较差异无统计学意义(P>0.05)。结论:用绝缘的针状电极于单侧卵巢上负荷800~1 000 J的电能是治疗顽固性PCOS患者的有效方法;再增加卵巢所负荷电能,可能增加卵巢功能衰竭的风险;观察LOD术后患者卵巢血供可提示并预测卵巢功能状态。

Study on the effect of amount of thermal energy required for laparoscopy on ultrasonic images of ovary and endocrine function in the treatment of clomiphene-resistant polycystic ovary syndrome

Objective:To explore the optimal amount of themal energy required for laparoscopic ovarian diathermy(LOD) in women with clomiphene-resistant polycystic ovary syndrome(PCOS) and its effect on ultrasonic images of ovary and endocrine function after treatment.Methods:60 women with clomiphene-resistant PCOS were divided into two groups according to the intensity of electricity applied on ovaries.Changes of endocrine function,ovarian blood flow in follicular phase,ovulatory period and luteal phase were observed and recorded.Results:The levels of luteinizing hormone(LH),testosterone(T) and LH/follicule-stimulating hormone(FSH) in group Ⅰ were significantly lower than those in group Ⅱ after LOD(P<0.05),while the levels of LH,T and LH/FSH after LOD were lower than those before LOD in group Ⅱ,without significant difference(P>0.05);the peak systolic velocity(S) and end diastolic velocity(D) of ovary trunk artery and ovary stroma artery in group Ⅰ were significantly higher than those in group II after LOD,the resistance index(RI) reversed(P<0.05),no significant difference was found in aforementioned indexes between group Ⅰ and healthy women(P>0.05).Conclusion:The amount of 800～1000 J of electricity on each side of ovary in LOD is effective for women with clomiphene-resistant PCOS;while higher intensity may cause excessive destruction to the ovary;the observation of the ovary blood flow can indicate and foretell ovarian function.