腹腔镜卵巢打孔术联合经阴道未成熟卵泡穿刺术治疗难治性多囊卵巢综合征短期性激素水平变化观察

目的观察腹腔镜卵巢打孔术(LOD)联合经阴道未成熟卵泡穿刺术(IMFA)治疗难治性多囊卵巢综合征(PCOS)的短期性激素水平的影响。方法选取2014年3月至2016年9月中国人民解放军中部战区总医院收治的90例难治性PCOS患者进行前瞻性研究。按随机数字表法分为观察组(n=45)与对照组(n=45)。对照组采取LOD治疗,观察组采取LOD联合IMFA治疗。比较两组术中打孔热能、子宫内膜炎与子宫内膜异位症发生率、术中与术后并发症或不良反应发生率、术前及术后3个月后的血清黄体生成素(LH)、雄烯二酮(A)、游离雄激素指数(FAI)、抗米勒管激素(AMH)、卵巢动脉收缩期最大流速(Vmax)、阻力指数(RI)、卵巢体积、术后3个月内的自发排卵恢复率与促排卵治疗的有效率,随访至2018年2月的临床妊娠率、流产率、多胎率。结果两组术中打孔热能、子宫内膜炎与盆腔子宫内膜异位症发生率及术后盆腔感染、恶心呕吐发生率差异均无统计学意义(P>0.05)。两组术后的血清LH、A、FAI、AMH均较术前显著下降(P<0.05),两组术后的血清A与PAI水平差异无统计学意义(P>0.05),观察组术后的血清LH与AMH水平分别为(7.35±2.74)mIU/mL与(9.24±2.84)ng/mL,显著低于对照组(8.65±2.90)mIU/mL与(10.61±3.01)ng/mL(P<0.05)。两组术后的卵巢动脉收缩期Vmax均较术前增大、RI与卵巢体积较术前减小(P<0.05);观察组术后的卵巢动脉收缩期Vmax为(27.95±2.63)cm/s,显著高于对照组(25.16±2.37)cm/s,RI、卵巢体积分别为(0.60±0.06)与(6.48±1.21)cm 3,显著低于对照组(0.64±0.07)与(7.25±1.36)cm 3(P<0.05)。术后3个月内,观察组与对照组自主排卵恢复率分别为40.00%与35.56%,差异无统计学意义(P>0.05)。观察组促排卵治疗有效率为77.78%,显著高于对照组的44.83%(P﹤0.05)。随访期间观察组临床妊娠率、流产率、多胎率分别为46.51%、5.00%与5.00%,对照组为38.64%、11.76%与11.76%,两组比较差异无统计学意义(P>0.05)。结论LOD联合IMFA治疗难治性PCOS可有效改善短期性激素水平与卵巢功能状态,提高促排卵药物的敏感性,效果优于单独采用LOD。

Short-term changes of sex hormone levels in patients with refractory polycystic ovary syndrome treated by laparoscopic ovarian drilling combined with transvaginal immature follicular centesis

Objective To observe the effect of laparoscopic ovarian drilling(LOD)combined transvaginal immature follicles aspiration(IMFA)on short-term sex hormone levels in the treatment of refractory polycystic ovary syndrome(PCOS).Methods A total of 90 patients with refractory PCOS admitted to Central Theater General Hospital of Chinese People′s Liberation Army from March 2014 to September 2016 were conducted prospective study.They were divided into observation group(n=45)and control group(n=45)according to the random number table method.The control group was treated with LOD,while the observation group was treated with LOD combined with transvaginal IMFA.Compare two groups of intraoperative drilling heat,endometritis with endometriosis incidence,the incidence of intraoperative and postoperative complications or adverse reactions,preoperative and postoperative 3 months after the serum luteinizing hormone(LH),androstenedione(A),free androgen index(FAI)and anti Mullerian hormone(AMH),ovarian artery systolic maximum velocity(Vmax),resistance index(RI),ovarian volume,postoperative 3 months of spontaneous recovery rate of ovulation and stimulate ovulation treatment efficiently,and the clinical pregnancy rate,abortion rate and multiple birth rate of follow-up to February 2018.Results There were no statistically significant differences between the two groups in terms of intraoperative drilling thermal energy,incidence of endometritis and pelvic endometriosis,incidence of postoperative pelvic infection,nausea and vomiting(P>0.05).Serum LH,A,FAI and AMH in the two groups were significantly decreased compared with those before surgery(P<0.05).The postoperative serum A and PAI levels in the two groups were not statistically significant(P>0.05).The postoperative serum LH and AMH levels in the observation group were(7.35±2.74)mIU/mL and(9.24±2.84)ng/mL,respectively,which were significantly lower than those in the control group(8.65±2.90)mIU/mL and(10.61±3.01)ng/mL(P<0.05).The postoperative Vmax of ovarian artery systolic period in both groups increased compared with that before surgery,and RI and ovarian volume decreased compared with that before surgery(P<0.05).The postoperative systolic Vmax of the ovary in the observation group was(27.95±2.63)cm/s,which was significantly higher than that of the control group(25.16±2.37)cm/s.The RI and ovarian volumes were(0.60±0.06)and(6.48±1.21)cm 3,respectively,which were significantly lower than that of the control group(0.64±0.07)and(7.25±1.36)cm 3(P<0.05).Three months after the operation,the self-ovulation recovery rates of the observation group and the control group were 40.00%and 35.56%,respectively,with no statistically significant difference(P>0.05).The effective rate of ovulation induction treatment in the observation group was 77.78%,significantly higher than that in the control group(44.83%,P<0.05).During the follow-up period,the clinical pregnancy rate,abortion rate and multiple birth rate in the observation group were 46.51%,5.00%and 5.00%,respectively,while those in the control group were 38.64%,11.76%and 11.76%,with no statistically significant difference(P>0.05).Conclusions LOD combined with IMFA in the treatment of refractory PCOS can effectively improve the short-term sex hormone level and ovarian function,improve the sensitivity of ovulation induction drugs,and the effect is better than LOD alone.