腹腔镜下三种术式对卵巢子宫内膜异位囊肿术后卵巢储备功能的影响

发布时间：2018-02-20 16:20

本文关键词： 卵巢子宫内膜异位囊肿不孕症腹腔镜囊肿壁电灼术卵巢储备功能　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨卵巢子宫内膜异位囊肿(以下简称内异囊肿)合并不孕患者行腹腔镜下内异囊肿切开放液术、腹腔镜下内异囊肿切开放液+囊壁电灼术和腹腔镜下内异囊肿剥除术三种术式对卵巢储备功能的影响。方法：回顾性收集2011年5月-2013年9月83例患者,所有患者术前均有内异囊肿合并不孕病史,根据不同术式分成3组。A组32例,行腹腔镜下内异囊肿切开放液术；B组25例,行腹腔镜下内异囊肿切开放液+囊壁电灼术；C组26例,行腹腔镜下内异囊肿剥除术。分别测定3组患者术前、术后第1次月经和第3次月经第2-3天的基础卵泡刺激素(bFSH)、雌二醇(bE2)水平及术前术后分别经阴道B超测术侧卵巢和健侧卵巢的窦状卵泡数以及总窦卵泡数,以比较卵巢储备功能。结果： A组：术后第一次bFSH、bE2与术前相比有明显改善,差异有显著性(P0.05)；B组：术后第一次bFSH与术前bFSH相比有明显改善,差异有显著性(P0.05),术后总窦卵泡数与术前总窦卵泡数相比有明显增加,差异也有显著性(P0.05)；C组：术后第一次bFSH与术前bFSH相比无显著性差异。三组术前bFSH、bE2无显著性差异,A组与B组术前术侧窦卵泡数、总窦卵泡数无显著性差异,但与C组相比均有显著性差异(P0.05),C组术前术侧窦卵泡数和总窦卵泡数明显多于A组与B组。A组、B组术前bFSH与术后第一次bFSH差值与C组相比有显著性差异(P0.05),A组、B组术后第一次bFSH改善较C组明显。A组、B组术侧窦卵泡数手术前后差值与C组相比也有显著性差异(P0.05),A组、B组术侧窦卵泡数术后增加数目明显多于C组。B组手术前后总窦卵泡数差值与A组、C组相比有显著性差异(P0.05),B组总窦卵泡数术后增加明显多于A组、C组(P0.05)。结论：子宫内膜异位症合并不孕症患者特别是术前合并卵巢储备功能下降患者行腹腔镜内异囊肿切开放液术或切开放液+囊壁电灼术与传统腹腔镜下内异囊肿剥除术相比,前两种术式更有利于保护卵巢储备功能,术后第一次bFSH有明显下降,并可增加窦卵泡数,有助于改善卵巢储备功能,可能有助于提高生育力。切开放液术与切开放液+囊壁电灼术相比,后者更有利于增加总窦卵泡数,可能更有利于提高获卵率,是可以优选的手术方式。
[Abstract]:Objective:. To investigate the laparoscopic incision and exudation of endometriosis cyst (endometriosis cyst) combined with infertility in patients with ovarian endometriosis. Effects of laparoscopic excision and excision of internal cyst on ovarian reserve function. Methods:. From May 2011 to September 2013, 83 patients were retrospectively collected. All the patients had history of infertility before operation. According to different operation methods, 32 cases were divided into three groups: group A (n = 32) and group B (n = 25). Group C (n = 26) underwent laparoscopic excision and exfoliation of endocyst (n = 26). The levels of basal follicle stimulating hormone (bFSH), estradiol (E _ 2) and the number of antral follicles and the number of common antral follicles in the ovaries and normal ovaries were measured before and after the first menstruation and 2-3 days after the third menstruation, respectively, to compare the reserve function of the ovaries. Results:. Group A: the first postoperative bFSHN bE2 was significantly improved compared with that before operation, and the difference was significant (P 0.05): the first postoperative bFSH was significantly improved compared with the preoperative bFSH, the difference was significant (P0.05), and the number of total antral follicles was significantly increased compared with the preoperative total antral follicles. There was no significant difference in the number of antral follicles and the total number of antral follicles between group A and group B before operation, and there was no significant difference between group A and group B in the number of lateral antral follicles and the number of total antral follicles in the first time after operation compared with bFSH before operation, but there was no significant difference in the number of follicles between group A and group B before operation. However, there were significant differences in the number of antral follicles and total antral follicles between group C and group C before operation than between group A and group B (P 0.05) and the difference of the first bFSH between group A and group B (P 0.05) and the difference between group B (P 0.05) and group B (P 0.05). The difference in the number of antral follicles before and after operation in group A was significantly higher than that in group C (P 0.05). The number of antral follicles in group B was significantly higher than that in group C (P 0.05). The number of antral follicles in group B was significantly higher than that in group C before and after operation. There was significant difference in the number of follicles between group A and group C. The number of total antral follicles in group B was significantly higher than that in group A (P 0.05). Conclusion:. The patients with endometriosis complicated with infertility, especially the patients with ovarian reserve dysfunction before operation, were treated with laparoscopic endocyst incision and fluid exfoliation or incision of cystic wall cauterization, compared with the traditional laparoscopic excision of endometriosis. The first two methods were more helpful to protect ovarian reserve function, bFSH decreased significantly at the first time after operation, and increased the number of antral follicles, which was helpful to improve ovarian reserve function. Compared with electrocautery, the latter is more favorable to increase the number of follicles in the common antrum, and may be more favorable to increase the rate of oocyte acquisition, which is the best method of operation.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

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