改良腹腔镜剥离术式对卵巢子宫内膜异位症患者皮质剥除率、卵泡生成及卵巢体积的影响
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摘要
目的探讨改良腹腔镜剥离术式对卵巢子宫内膜异位症患者皮质剥除率、卵泡生成及卵巢体积的影响,为卵巢子宫内膜异位症的治疗提供理论依据。方法选取2014年1月-2016年12月泰州市第二人民医院收治的卵巢子宫内膜异位症患者80例为研究对象,以随机数字表法分为对照组(40例)和观察组(40例),分别采用腹腔镜常规钝性剥离术与改良锐性剥离术治疗;比较两组患者卵巢皮质剥除率,卵巢皮质剥除厚度,病灶剥除厚度,手术前后血清性激素水平、患侧卵巢卵泡数、卵巢体积及随访妊娠率。结果观察组患者卵巢门皮质剥除率显著低于对照组(P<0.05),观察组患者中间部位病灶剥除厚度和卵巢皮质剥除厚度均显著低于对照组(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)。观察组患者术后6个月患侧卵巢卵泡数显著高于对照组(P<0.05)。两组患者术后6个月卵巢体积均显著小于术前(P<0.05),且观察组患者术后6个月卵巢体积显著大于对照组(P<0.05)。观察组患者随访妊娠率显著高于对照组(P<0.05)。结论相较于常规腹腔镜剔除术,改良腹腔镜剥离术式治疗卵巢子宫内膜异位症可显著降低卵巢门皮质剥除量,减少初级和次级卵泡丢失,并有助于提高远期妊娠率。
Objective To explore the effect of modified laparoscopic dissection on cortical exfoliation rate,follicular formation,and ovarian volume of patients with ovarian endometriosis,provide a theoretical basis for treatment of ovarian endometriosis.Methods From January 2014 to December 2016,80 patients with ovarian endometriosis treated in the Second People's Hospital of Taizhou were selected and divided into control group and observation group according to random number table,40 patients in each group.The patients in the two groups were treated by conventional laparoscopic blunt dissection and modified laparoscopic dissection,respectively.Cortical exfoliation rates and thicknesses,lesion exfoliation thicknesses,serum sex homone levels before and after surgery,the numbers of follicles of affected side,ovarian volumes,and follow-up pregnancy rates in the two groups were compared.Results Cortical exfoliation rate in observation group was statistically significantly lower than that in control group( P < 0.05).The exfoliation thicknesses of central lesion and cortex in observation group were statistically significantly lower than those in control group( P<0.05).There was no statistically significant difference in the levels of sex hormones before and after surgery between the two groups( P>0.05).At six months after surgery,the number of follicles of affected side in observation group was statistically significantly higher than that in control group( P<0.05),ovarian volumes in the two groups were statistically significantly less than those before surgery( P<0.05),ovarian volumes in observation group was statistically significantly larger than that in control group( P<0.05).The follow-up pregnancy rate in observation group was statistically significantly higher than that in control group( P<0.05).Conclusion Compared with conventional laparoscopic blunt dissection,modified laparoscopic dissection can significantly reduce the number of cortical exfoliation,eliminate loss of primary and secondary follicles,and increase long-term pregnancy rate in treatment of ovarian endometriosis.
Objective To explore the effect of modified laparoscopic dissection on cortical exfoliation rate,follicular formation,and ovarian volume of patients with ovarian endometriosis,provide a theoretical basis for treatment of ovarian endometriosis.Methods From January 2014 to December 2016,80 patients with ovarian endometriosis treated in the Second People's Hospital of Taizhou were selected and divided into control group and observation group according to random number table,40 patients in each group.The patients in the two groups were treated by conventional laparoscopic blunt dissection and modified laparoscopic dissection,respectively.Cortical exfoliation rates and thicknesses,lesion exfoliation thicknesses,serum sex homone levels before and after surgery,the numbers of follicles of affected side,ovarian volumes,and follow-up pregnancy rates in the two groups were compared.Results Cortical exfoliation rate in observation group was statistically significantly lower than that in control group( P < 0.05).The exfoliation thicknesses of central lesion and cortex in observation group were statistically significantly lower than those in control group( P<0.05).There was no statistically significant difference in the levels of sex hormones before and after surgery between the two groups( P>0.05).At six months after surgery,the number of follicles of affected side in observation group was statistically significantly higher than that in control group( P<0.05),ovarian volumes in the two groups were statistically significantly less than those before surgery( P<0.05),ovarian volumes in observation group was statistically significantly larger than that in control group( P<0.05).The follow-up pregnancy rate in observation group was statistically significantly higher than that in control group( P<0.05).Conclusion Compared with conventional laparoscopic blunt dissection,modified laparoscopic dissection can significantly reduce the number of cortical exfoliation,eliminate loss of primary and secondary follicles,and increase long-term pregnancy rate in treatment of ovarian endometriosis.
引文
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[3]Johnson NP,Hummelshoj L,World Endometriosis Society Montpellier Consortium.Consensus on current management of endometriosis[J].Hum Reprod,2013,28(6):1552-1568.
[4]中华医学会妇产科学分会EMs症协作组.EMs症的诊治指南[J].中华妇产科杂志,2015,50(30):161-169.
[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 R B,2011,157(2):212-216.
[7]Takehito I,Khaleque NK,Akira F.Effect of GnRH agonist therapy on the expression of human heat shock protein 70 in eutopic and ectopic endometria of women with endometriosis[J].Eur J Obstet Gynecol Reprod Biol,2014,157(9):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,2012,95(5):1574-1578.
[9]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.
[10]江楠,岳倩,段玉英.注垂体后叶素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.
[11]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.
[12]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.
[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 RG,Dhulked S,Ramachandran A,et al.Laparoscopic cystectomy of endometrioma:good surgical technique does not adversely affect ovarian reserve[J].J Hum Reprod,2014,7(2):125-129.
[15]Georgievska J,Sapunov S,Cekovska S,et al.Effect of two laparoscopic techniques for treatment of ovarian endometrioma on ovarian reserve[J].Med Arch,2015,69(2):88-90.
[2]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.
[3]Johnson NP,Hummelshoj L,World Endometriosis Society Montpellier Consortium.Consensus on current management of endometriosis[J].Hum Reprod,2013,28(6):1552-1568.
[4]中华医学会妇产科学分会EMs症协作组.EMs症的诊治指南[J].中华妇产科杂志,2015,50(30):161-169.
[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 R B,2011,157(2):212-216.
[7]Takehito I,Khaleque NK,Akira F.Effect of GnRH agonist therapy on the expression of human heat shock protein 70 in eutopic and ectopic endometria of women with endometriosis[J].Eur J Obstet Gynecol Reprod Biol,2014,157(9):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,2012,95(5):1574-1578.
[9]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.
[10]江楠,岳倩,段玉英.注垂体后叶素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.
[11]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.
[12]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.
[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 RG,Dhulked S,Ramachandran A,et al.Laparoscopic cystectomy of endometrioma:good surgical technique does not adversely affect ovarian reserve[J].J Hum Reprod,2014,7(2):125-129.
[15]Georgievska J,Sapunov S,Cekovska S,et al.Effect of two laparoscopic techniques for treatment of ovarian endometrioma on ovarian reserve[J].Med Arch,2015,69(2):88-90.
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