不同腹腔镜剥离术式对子宫内膜异位症患者性激素、窦卵泡数及卵巢体积的影响
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摘要
目的探讨腹腔镜下常规钝性剔除与改良锐性剥离术式对子宫内膜异位症(EMs)患者性激素、窦卵泡数(AFC)及卵巢体积的影响。方法选取该院2013年1月-2016年4月收治EMs患者共100例,按随机数字表法分为对照组(50例)和观察组(50例),分别给予腹腔镜下常规钝性剔除与改良锐性剥离术式治疗;比较两组患者剥除病灶厚度、卵巢皮质剥除率、卵巢皮质剥除厚度、手术前后血清性激素水平、患侧卵巢AFC及卵巢体积。结果两组患者卵巢窝部位剥除病灶厚度、卵巢皮质剥除率及卵巢皮质剥除厚度比较差异无统计学意义(P>0.05);观察组患者中间部位剥除病灶厚度和卵巢皮质剥除厚度均明显低于对照组(P<0.05);观察组患者卵巢门剥除病灶厚度、卵巢皮质剥除厚度和卵巢皮质剥除率均明显低于对照组(P<0.05);两组患者手术前后性激素水平比较差异无统计学意义(P>0.05);观察组患者手术前后患侧卵巢AFC水平比较差异无统计学意义(P>0.05);对照组患者术后患侧卵巢AFC水平明显低于术前(P<0.05);两组患者术后卵巢体积均明显小于术前(P<0.05);观察组患者术后卵巢体积明显大于对照组(P<0.05)。结论腹腔镜下改良锐性剥离术式治疗EMs患者可有效减少卵巢门皮质剥除量,降低初级和次级卵泡丢失程度,价值优于常规钝性剥离术式。
Objective To investigate the impact of different kinds of laparoscopic surgery including conventional blunt elimination and modified acute elimination on sex hormone, antral follicle count and ovarian volume of patients with endometriosis(EMs). Methods 100 patients with EMs were chosen from January 2013 to April 2016 and randomly divided into control group(50 patients) with conventional blunt elimination and observation group(50 patients) with modified acute elimination; and the thickness of elimination lesion, the removal rate of ovary cortex, the thickness of ovarian cortex, the level of serum sex hormones, the AFC number of affected side and the volume of ovary before and after operation of the two groups were compared. Results There was no significant difference in the thickness of lesion elimination, the removal rate and removed thickness of ovarian cortical between the two groups(P > 0.05). The thickness of lesion elimination and the thickness of ovarian cortex in middle position of observation group were significantly lower than that in control group(P < 0.05). The thickness of lesion elimination, removed thickness of ovarian cortical and the removal rate of ovary cortex in hilus ovarii in observation group were significantly lower than that in control group(P < 0.05). There was no significant difference in the levels of serum sex hormones before and after treatment between the two groups(P > 0.05). There was no significant difference in the levels of AFC number of affected side before and after treatment(P>0.05).The levels of AFC number of affected side in hilus ovarii of control group after treatment were significantly lower than that before treatment(P<0.05).The volume of ovary of both groups after treatment were significantly lower than that before treatment(P<0.05).The volume of ovary of observation group after treatment were significantly higher than that in control group(P<0.05).Conclusion Compared with conventional blunt elimination,modified acute elimination in the treatment of patients with EMs can efficiently shorten the operation time,reduce the surgical trauma degree,speed up the recovery process after operation,regulate the level of FSH and AMH and be helpful to protect the ovarian reserve function.
Objective To investigate the impact of different kinds of laparoscopic surgery including conventional blunt elimination and modified acute elimination on sex hormone, antral follicle count and ovarian volume of patients with endometriosis(EMs). Methods 100 patients with EMs were chosen from January 2013 to April 2016 and randomly divided into control group(50 patients) with conventional blunt elimination and observation group(50 patients) with modified acute elimination; and the thickness of elimination lesion, the removal rate of ovary cortex, the thickness of ovarian cortex, the level of serum sex hormones, the AFC number of affected side and the volume of ovary before and after operation of the two groups were compared. Results There was no significant difference in the thickness of lesion elimination, the removal rate and removed thickness of ovarian cortical between the two groups(P > 0.05). The thickness of lesion elimination and the thickness of ovarian cortex in middle position of observation group were significantly lower than that in control group(P < 0.05). The thickness of lesion elimination, removed thickness of ovarian cortical and the removal rate of ovary cortex in hilus ovarii in observation group were significantly lower than that in control group(P < 0.05). There was no significant difference in the levels of serum sex hormones before and after treatment between the two groups(P > 0.05). There was no significant difference in the levels of AFC number of affected side before and after treatment(P>0.05).The levels of AFC number of affected side in hilus ovarii of control group after treatment were significantly lower than that before treatment(P<0.05).The volume of ovary of both groups after treatment were significantly lower than that before treatment(P<0.05).The volume of ovary of observation group after treatment were significantly higher than that in control group(P<0.05).Conclusion Compared with conventional blunt elimination,modified acute elimination in the treatment of patients with EMs can efficiently shorten the operation time,reduce the surgical trauma degree,speed up the recovery process after operation,regulate the level of FSH and AMH and be helpful to protect the ovarian reserve function.
引文
[1]BOURDEL N,DEJOU-BOUILLET L,ROMAN H,et al.Endometriosis and postoperative infertility.A prospective study(Auvergne cohort of endometriosis)[J].Gynecol Obstet Fertil,2012,40(6):337-343.
[2]VERCELLINI P,CROSIGNANI P,SOMIGLIANA E,et al.Waiting for Godot:a commonsense approach to the medical treatment of endometriosis[J].Human Reproduction,2011,26(1):3-13.
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[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治指南[J].中华妇产科杂志,2015,50(3):161-169.[4]The Endometriosis Collaborative Group in the Branch of Obstetrics and Gynecology of Chinese Medical Association.The diagnosis and treatment guideline of endometriosis[J].Chin J Obstet Gynecol,2015,50(3):161-169.Chinese
[5]HAAS D,CHVATAL R,HABELSBERGER A,et al.Comparison of revised american fertility society and enzian staging:a critical evaluation of classifications of endometriosis on the basis of our patient population[J].Fertil Steril,2011,95(5):1574-1578.
[6]KITAWAKI J,KUSUKI I,YAMANAKA K,et al.Maintenance therapy with dienogest following gonadotropin-releasing hormone agonist treatment for endometriosis-associated pelvic pain[J].Eur J Obstet Gyn Reprod Biol,2011,157(2):212-216.
[7]IMAMURA T,KHAN K N,FUJISHITA A,et al.Effect of Gn RH agonist therapy on the expression of human heat shock protein 70in eutopic and ectopic endometria of women with endometriosis[J].Eur J Obstet Gynecol Reprod Biol,2014,180:16-23.
[8]HAAS D,CHVATAL R,HABELSBERGER A,et al.Comparison of revised American fertility society and ENZIAN staging:a critical evaluation of classifications of endometriosis on the basis of our patient population[J].Fertil Steril,2011,95(5):1574-1578.
[9]江楠,岳倩,段玉英,等.垂体后叶素水分离法在腹腔镜下卵巢子宫内膜异位症囊肿剥除术中的应用及对卵巢功能的影响[J].现代妇产科进展,2013,22(7):581-583.[9]JIANG N,YUE Q,DUAN Y Y,et al.Application of pituitrin hydrodissection on laparoscopic cystectomy for ovarian endometriosis and its effect on ovarian function[J].Progress in Obstetrics and Gynecology,2013,22(7):581-583.Chinese
[10]SHI J,LENG J,CUI Q,et al.Follicle loss after laparoscopic treatment of ovarian endometriotic cysts[J].Int J Gynaecol Obstet,2011,115(3):277-281.
[11]赵万成,杨清,王丹丹.注水分离法在腹腔镜卵巢子宫内膜异位症囊肿剥除术中的应用价值[J].现代妇产科进展,2013,22(11):912-914.[11]ZHAO W C,YANG Q,WANG D D.The application value of hydrodissection on laparoscopic cystectomy for ovarian endometriosis[J].Progress in Obstetrics and Gynecology,2013,22(11):912-914.Chinese
[12]GEORGIEVSKA J,SAPUNOV S,CEKOVSKA S,et al.Effect of two laparoscopic techniques for treatment of ovarian endometrioma on ovarian reserve[J].Medical Archives,2015,69(2):88-90.
[13]RAMACHANDRAN A,DHULKHED S,BHAKTA R,et al.Influence of endomeriotic cyst diameter and the severity of endometriosis on the ovarian parenchyma excised during laparoscopic cystectomy[J].J Clin Diagn Res,2013,7(10):2241-2243.
[14]BHAT R G,DHULKED S,RAMACHANDRAN A,et al.Laparoscopic cystectomy of endometrioma:good surgical technique does not adversely affect ovarian reserve[J].J Hum Reprod Sci,2014,7(2):125-129.
[2]VERCELLINI P,CROSIGNANI P,SOMIGLIANA E,et al.Waiting for Godot:a commonsense approach to the medical treatment of endometriosis[J].Human Reproduction,2011,26(1):3-13.
[3]PAPALEO E,OTTOLINA J,VIGANO P,et al.Deep pelvic endometriosis negatively affects ovarian reserve and the number of oocytes retrieved for in vitro fertilization[J].Acta Obstet Gynecol Scand,2011,90(8):878-884.
[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治指南[J].中华妇产科杂志,2015,50(3):161-169.[4]The Endometriosis Collaborative Group in the Branch of Obstetrics and Gynecology of Chinese Medical Association.The diagnosis and treatment guideline of endometriosis[J].Chin J Obstet Gynecol,2015,50(3):161-169.Chinese
[5]HAAS D,CHVATAL R,HABELSBERGER A,et al.Comparison of revised american fertility society and enzian staging:a critical evaluation of classifications of endometriosis on the basis of our patient population[J].Fertil Steril,2011,95(5):1574-1578.
[6]KITAWAKI J,KUSUKI I,YAMANAKA K,et al.Maintenance therapy with dienogest following gonadotropin-releasing hormone agonist treatment for endometriosis-associated pelvic pain[J].Eur J Obstet Gyn Reprod Biol,2011,157(2):212-216.
[7]IMAMURA T,KHAN K N,FUJISHITA A,et al.Effect of Gn RH agonist therapy on the expression of human heat shock protein 70in eutopic and ectopic endometria of women with endometriosis[J].Eur J Obstet Gynecol Reprod Biol,2014,180:16-23.
[8]HAAS D,CHVATAL R,HABELSBERGER A,et al.Comparison of revised American fertility society and ENZIAN staging:a critical evaluation of classifications of endometriosis on the basis of our patient population[J].Fertil Steril,2011,95(5):1574-1578.
[9]江楠,岳倩,段玉英,等.垂体后叶素水分离法在腹腔镜下卵巢子宫内膜异位症囊肿剥除术中的应用及对卵巢功能的影响[J].现代妇产科进展,2013,22(7):581-583.[9]JIANG N,YUE Q,DUAN Y Y,et al.Application of pituitrin hydrodissection on laparoscopic cystectomy for ovarian endometriosis and its effect on ovarian function[J].Progress in Obstetrics and Gynecology,2013,22(7):581-583.Chinese
[10]SHI J,LENG J,CUI Q,et al.Follicle loss after laparoscopic treatment of ovarian endometriotic cysts[J].Int J Gynaecol Obstet,2011,115(3):277-281.
[11]赵万成,杨清,王丹丹.注水分离法在腹腔镜卵巢子宫内膜异位症囊肿剥除术中的应用价值[J].现代妇产科进展,2013,22(11):912-914.[11]ZHAO W C,YANG Q,WANG D D.The application value of hydrodissection on laparoscopic cystectomy for ovarian endometriosis[J].Progress in Obstetrics and Gynecology,2013,22(11):912-914.Chinese
[12]GEORGIEVSKA J,SAPUNOV S,CEKOVSKA S,et al.Effect of two laparoscopic techniques for treatment of ovarian endometrioma on ovarian reserve[J].Medical Archives,2015,69(2):88-90.
[13]RAMACHANDRAN A,DHULKHED S,BHAKTA R,et al.Influence of endomeriotic cyst diameter and the severity of endometriosis on the ovarian parenchyma excised during laparoscopic cystectomy[J].J Clin Diagn Res,2013,7(10):2241-2243.
[14]BHAT R G,DHULKED S,RAMACHANDRAN A,et al.Laparoscopic cystectomy of endometrioma:good surgical technique does not adversely affect ovarian reserve[J].J Hum Reprod Sci,2014,7(2):125-129.
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