腹腔镜下卵巢巧克力囊肿剥除术联合GnRHa对卵巢功能的影响
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摘要
目的:探讨腹腔镜下卵巢巧克力囊肿剥除术联合促性腺激素释放激素激动剂(GnRHa)临床预后及对卵巢功能的影响。方法:将本院治疗的92例卵巢巧克力囊肿患者按随机数字表法分为观察组与对照组各46例。两组均行腹腔镜下巧克力囊肿剥除术,观察组术后应用GnRHa注射3次。比较两组症状缓解情况、术后复发率及妊娠率。术前及术后3、6个月测定血清性激素(LH、FSH、E_2)、抗穆勒氏管激素(AMH)水平,超声检查测定卵巢间质动脉血流的收缩期峰值(PSV)、窦状卵泡数(AFC)、卵巢体积(Vo)。结果:治疗总有效率观察组(97.8%)与对照组(93.5%)比较未见差异(P>0.05);术后6个月,两组月经期、痛经VAS评分、骨密度(BMD)、改良Kupperman评分和围绝经期综合征发生率比较无差异(P>0.05);术后3个月,观察组的FSH高于对照组,LH、E_2、AMH低于对照组(P<0.05);术后6个月两组血清FSH、LH、E_2、AMH及PSV、AFC、Vo比较无差异(P>0.05);术后复发率观察组(6.8%)低于对照组(22.0%),妊娠率观察组(70.6%)高于对照组(30.0%)(均P<0.05)。结论:腹腔镜卵巢下巧克力囊肿剥除术后联合GnRHa对疗效及卵巢功能无明显影响,但减少了术后复发率并提高近期妊娠率。
Objective: To investigate the effect of laparoscopic surgery combined with gonadotropin-releasing hormone agonists(GnRHa) for treating patients with ovarian chocolate cysts, and to explore its influence on ovarian function of patients. Methods: 92 patients with ovarian chocolate cysts were randomly divided into observation group and control group(46 cases in each group).The patients in both groups underwent laparoscopic chocolate cystectomy, and patients in observation group received GnRHa injection 3 times after surgery. The rates of symptom relief, postoperative recurrence, and pregnancy were compared between the two groups. Serum levels of sex hormones(LH, FSH, E_2) and anti-Mullerian hormone(AMH) were determined before and at 3 and 6 months after surgery. The peak systolic peak(PSV) of ovarian interstitial arterial blood flow, antral follicle number(AFC), ovary volume(OV) were measure by ultrasonography. Results: There was no significant difference in total effective rate between the observation group and the control group(97.8% VS 93.5%, P>0.05). At 6 months after surgery, there were no significant different in the time of menstrual period, VAS scores, bone mineral density(BMD), modified Kupperman score and the incidence of perimenopausal syndrome between the two groups(P>0.05). At 3 months after surgery, the level FSH of patients in observation group was significant higher than that of patients in control group, but levels of LH, E_2, and AMH were significant lower(P<0.05). 6 months after operation, there were no significant differences in serum FSH, LH, E_2, and AMH, and in PSV, AFC, OV between the two groups(P>0.05). The recurrence rate of patients in observation group was 6.8%, which was significant lower than that(22.0%) of patients in control group(P<0.05). The postoperative pregnancy rate of patients in observation group was 70.6%, which was significant higher than that(30.0%) of patients in control group(P<0.05). Conclusion: Laparoscopic cystectomy combined with GnRHa has no any
Objective: To investigate the effect of laparoscopic surgery combined with gonadotropin-releasing hormone agonists(GnRHa) for treating patients with ovarian chocolate cysts, and to explore its influence on ovarian function of patients. Methods: 92 patients with ovarian chocolate cysts were randomly divided into observation group and control group(46 cases in each group).The patients in both groups underwent laparoscopic chocolate cystectomy, and patients in observation group received GnRHa injection 3 times after surgery. The rates of symptom relief, postoperative recurrence, and pregnancy were compared between the two groups. Serum levels of sex hormones(LH, FSH, E_2) and anti-Mullerian hormone(AMH) were determined before and at 3 and 6 months after surgery. The peak systolic peak(PSV) of ovarian interstitial arterial blood flow, antral follicle number(AFC), ovary volume(OV) were measure by ultrasonography. Results: There was no significant difference in total effective rate between the observation group and the control group(97.8% VS 93.5%, P>0.05). At 6 months after surgery, there were no significant different in the time of menstrual period, VAS scores, bone mineral density(BMD), modified Kupperman score and the incidence of perimenopausal syndrome between the two groups(P>0.05). At 3 months after surgery, the level FSH of patients in observation group was significant higher than that of patients in control group, but levels of LH, E_2, and AMH were significant lower(P<0.05). 6 months after operation, there were no significant differences in serum FSH, LH, E_2, and AMH, and in PSV, AFC, OV between the two groups(P>0.05). The recurrence rate of patients in observation group was 6.8%, which was significant lower than that(22.0%) of patients in control group(P<0.05). The postoperative pregnancy rate of patients in observation group was 70.6%, which was significant higher than that(30.0%) of patients in control group(P<0.05). Conclusion: Laparoscopic cystectomy combined with GnRHa has no any
引文
[1] 陈慧. 腹腔镜手术联合促性腺激素释放激素激动剂治疗卵巢巧克力囊肿的疗效及对卵巢功能的影响[J]. 现代中西医结合杂志, 2015,24(20):2214-2216.
[2] 周新欢,崔金全,范中有,等.腹腔镜手术联合 GnRH-a 治疗卵巢巧克力囊肿合并不孕临床分析[J]. 中国妇幼保健,2013,28(15):2421-2424.
[3] 郝翠云. 腹腔镜手术联合促性腺激素释放激素激动剂(GnRH-a)治疗卵巢巧克力囊肿的疗效分析[J].中国现代医生,2016,54(19):67-69.
[4] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[5] 冷金花,戴毅.子宫内膜异位症诊治热点问题[J].中国实用妇科与产科杂志,2014,3(1):17-19.
[6] 赵影,颜磊.长效GnRHa在子宫内膜异位症合并不孕中的应用进展[J].国际生殖健康/计划生育杂志, 2017, 36(4):335-339.
[7] 周轶,宋莹.促性腺激素释放激素激动剂(GnRHa)对卵巢巧克力囊肿患者腹腔镜术后的临床疗效及其对卵巢功能的影响[J].实用药物与临床,2014,17(5):631-633.
[8] 孙华盛,张影,张利.腹腔镜下卵巢巧克力囊肿剔除术后联合应用GnRHa的疗效及其对卵巢功能的影响[J].海南医学,2014,25(13):1929-1930,1931.
[9] Nirgianakis K,Bersinger NA,McKinnon B,et al.Regression of the inflammatory microenvironment of the peritoneal cavity in women with endometriosis by GnRHa treatment[J]. Eur J Obstet Gynecol Reprod Biol,2013,170(2):550-554.
[10] 印慧琴.腹腔镜下卵巢子宫内膜异位囊肿剥除术联合GnRH-a对子宫内膜异位囊肿患者FSH、LH、E2的影响[J]. 中国妇幼保健, 2017, 32(18):4589-4591.
[11] Granese R,Perino A,Calagna G,et al.Gonadotrophinreleasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopie surgery for endometriosis:a multi-center randomized trial[J].Acta Obstet Gynecol Scand,2015,94(6):637-645.
[12] 杨春丽,潘瓷,杨敬敬等.GnRH-a 退缩疗法及常规疗法对不同体重子宫内膜异位症保守性手术后患者的疗效比较[J].广东医学,2016,37(4):616-620.
[13] 朱冬琴,周德兰,郑真霞,等.GnRH-a治疗子宫内膜异位症中雌激素反向添加治疗的个体化[J].江苏医药,2014,40(14):1670-1672.
[14] 高志红.腹腔镜手术联合GnRH-a治疗卵巢子宫内膜异位囊肿患者的临床观察[J]. 广西医科大学学报, 2016, 33(1):137-139.
[2] 周新欢,崔金全,范中有,等.腹腔镜手术联合 GnRH-a 治疗卵巢巧克力囊肿合并不孕临床分析[J]. 中国妇幼保健,2013,28(15):2421-2424.
[3] 郝翠云. 腹腔镜手术联合促性腺激素释放激素激动剂(GnRH-a)治疗卵巢巧克力囊肿的疗效分析[J].中国现代医生,2016,54(19):67-69.
[4] 中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[5] 冷金花,戴毅.子宫内膜异位症诊治热点问题[J].中国实用妇科与产科杂志,2014,3(1):17-19.
[6] 赵影,颜磊.长效GnRHa在子宫内膜异位症合并不孕中的应用进展[J].国际生殖健康/计划生育杂志, 2017, 36(4):335-339.
[7] 周轶,宋莹.促性腺激素释放激素激动剂(GnRHa)对卵巢巧克力囊肿患者腹腔镜术后的临床疗效及其对卵巢功能的影响[J].实用药物与临床,2014,17(5):631-633.
[8] 孙华盛,张影,张利.腹腔镜下卵巢巧克力囊肿剔除术后联合应用GnRHa的疗效及其对卵巢功能的影响[J].海南医学,2014,25(13):1929-1930,1931.
[9] Nirgianakis K,Bersinger NA,McKinnon B,et al.Regression of the inflammatory microenvironment of the peritoneal cavity in women with endometriosis by GnRHa treatment[J]. Eur J Obstet Gynecol Reprod Biol,2013,170(2):550-554.
[10] 印慧琴.腹腔镜下卵巢子宫内膜异位囊肿剥除术联合GnRH-a对子宫内膜异位囊肿患者FSH、LH、E2的影响[J]. 中国妇幼保健, 2017, 32(18):4589-4591.
[11] Granese R,Perino A,Calagna G,et al.Gonadotrophinreleasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopie surgery for endometriosis:a multi-center randomized trial[J].Acta Obstet Gynecol Scand,2015,94(6):637-645.
[12] 杨春丽,潘瓷,杨敬敬等.GnRH-a 退缩疗法及常规疗法对不同体重子宫内膜异位症保守性手术后患者的疗效比较[J].广东医学,2016,37(4):616-620.
[13] 朱冬琴,周德兰,郑真霞,等.GnRH-a治疗子宫内膜异位症中雌激素反向添加治疗的个体化[J].江苏医药,2014,40(14):1670-1672.
[14] 高志红.腹腔镜手术联合GnRH-a治疗卵巢子宫内膜异位囊肿患者的临床观察[J]. 广西医科大学学报, 2016, 33(1):137-139.