不同输卵管系膜状态子宫内膜异位囊肿患者术后血清抗苗勒管激素水平差异分析
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摘要
目的分析子宫内膜异位囊肿患者输卵管系膜状态与卵巢囊肿剥除术后血清抗苗勒管激素(AMH)水平的关系。方法选择2014年2月至2017年2月隆昌市人民医院收治的74例子宫内膜异位囊肿患者为研究对象,根据输卵管系膜是否粘连分为2组,系膜与囊肿或附件发生粘连者作为观察组(n=31),无粘连者作为对照组(n=43)。2组患者均给予卵巢囊肿剥除术,比较2组患者手术相关指标及剥除囊肿的组织学形态;分别于手术前后检测2组患者血清抗苗勒管激素(AMH)水平,观察2组患者术后卵巢储备功能恢复的差异。结果 2组患者手术时间、术中出血量和术后拔管时间比较差异均无统计学意义(P> 0. 05)。2组患者剥除囊肿直径和囊肿壁厚度比较差异均无统计学意义(P> 0. 05)。2组患者构成囊肿壁的主要细胞是卵巢间质细胞,囊壁上有明显的纤维化,且有大量的巨噬细胞存在。观察组和对照组患者卵泡存在率分别为41. 94%(13/31)、48. 84%(21/43),2组患者卵泡存在率比较差异无统计学意义(P> 0. 05)。术前2周,2组患者血清AMH水平比较差异无统计学意义(P> 0. 05)。2组患者术后3、12个月血清AMH水平均显著低于术前2周(P <0. 05),2组患者术后3、12个月血清AMH水平比较差异无统计学意义(P> 0. 05)。观察组患者术后3、12个月血清AMH水平均低于对照组(P <0. 05)。术前2周,2组患者窦卵泡计数(AFC)比较差异无统计学意义(P> 0. 05)。2组患者术后3个月AFC显著低于术前2周(P <0. 05);术后12个月,观察组患者AFC低于术前2周,对照组患者AFC显著高于术前2周(P <0. 05); 2组患者术后12个月AFC显著高于术后3个月(P <0. 05)。观察组患者术后3、12个月AFC显著低于对照组(P <0. 05)。结论卵巢子宫内膜异位囊肿合并输卵管系膜粘连患者行囊肿剥除术后血清AMH水平大幅下降,临床应实时监测AMH水平并加强干预。
Objective To analyze the difference of serum anti-mullerian hormone( AMH) levels in patients with endometriotic cysts with different mesosalpinal status after ovarian cystectomy. Methods A total of 74 patients with endometriosis cysts in the Longchang People' s Hospital from February 2014 to February 2017 were selected as the study subjects. The patients were divided into two groups according to whether or not the mesosalpinx was adhesive. Thirty-one patients with adhesion of mesosalpinx and cysts or adnexa uteri were selected as observation group,and 43 patients without adhesion were selected as control group. All patients were given ovarian cystectomy. The operation related indexes and the histological morphology of cysts was compared between the two groups. Serum levels of AMH were measured before and after operation,and the difference in the recovery of ovarian reserve function was observed between the two groups. Results There was no significant difference in the operation time,intraoperative blood loss and postoperative extubation time between the two groups( P > 0. 05). There was no significant difference in the cyst diameter and cyst wall thickness between the two groups( P > 0. 05). Pathological results showed that the main cells of the cyst wall in the two groups were ovarian stromal cells,with obvious fibrosis in the cyst wall and a large number of macrophages. The follicular existence rates of patients in the observation group and the control group were 41. 94%( 13/31) and 48. 84%( 21/43),respectively; there was no significant difference in the follicular existence rates between the two groups( P > 0. 05). There was no significant difference in the serum levels of AMH of patients between the two groups at 2 weeks before operation( P > 0. 05). The serum levels of AMH at 3,12 months after operation were significantly lower than those at two weeks before operation( P < 0. 05); there was no significant difference in the serum levels of AMH of patients between 3 months and 12 months after operation in the two groups( P > 0. 05). The serum level of AMH of patients in the observation group was significantly lower than that in the control group at 3,12 months after operation( P < 0. 05). There was no significant difference in the antral follicle count( AFC) between the two groups at 2 weeks before operation( P > 0. 05). The AFC of patients at 3 months after operation was significantly lower than that at 2 weeks before operation in the two groups( P < 0. 05). At 12 months after operation,the AFC of patients in the observation group was lower than that at 2 weeks before operation( P < 0. 05),while the AFC of patients in the control group was higher than that at 2 weeks before operation( P < 0. 05). The AFC at 12 months after operation was significantly higher than that at 3 months after operation in the two groups( P < 0. 05). The AFC of patients in the observation group was significantly lower than that in the control group at 3,12 months after operation( P < 0. 05). Conclusions The serum AMH level of patients with ovarian endometriosis cyst complicated with mesosalpingeal adhesions decreased significantly after cystectomy. It is necessary to monitor the AMH level and strengthen intervention in clinic.
Objective To analyze the difference of serum anti-mullerian hormone( AMH) levels in patients with endometriotic cysts with different mesosalpinal status after ovarian cystectomy. Methods A total of 74 patients with endometriosis cysts in the Longchang People' s Hospital from February 2014 to February 2017 were selected as the study subjects. The patients were divided into two groups according to whether or not the mesosalpinx was adhesive. Thirty-one patients with adhesion of mesosalpinx and cysts or adnexa uteri were selected as observation group,and 43 patients without adhesion were selected as control group. All patients were given ovarian cystectomy. The operation related indexes and the histological morphology of cysts was compared between the two groups. Serum levels of AMH were measured before and after operation,and the difference in the recovery of ovarian reserve function was observed between the two groups. Results There was no significant difference in the operation time,intraoperative blood loss and postoperative extubation time between the two groups( P > 0. 05). There was no significant difference in the cyst diameter and cyst wall thickness between the two groups( P > 0. 05). Pathological results showed that the main cells of the cyst wall in the two groups were ovarian stromal cells,with obvious fibrosis in the cyst wall and a large number of macrophages. The follicular existence rates of patients in the observation group and the control group were 41. 94%( 13/31) and 48. 84%( 21/43),respectively; there was no significant difference in the follicular existence rates between the two groups( P > 0. 05). There was no significant difference in the serum levels of AMH of patients between the two groups at 2 weeks before operation( P > 0. 05). The serum levels of AMH at 3,12 months after operation were significantly lower than those at two weeks before operation( P < 0. 05); there was no significant difference in the serum levels of AMH of patients between 3 months and 12 months after operation in the two groups( P > 0. 05). The serum level of AMH of patients in the observation group was significantly lower than that in the control group at 3,12 months after operation( P < 0. 05). There was no significant difference in the antral follicle count( AFC) between the two groups at 2 weeks before operation( P > 0. 05). The AFC of patients at 3 months after operation was significantly lower than that at 2 weeks before operation in the two groups( P < 0. 05). At 12 months after operation,the AFC of patients in the observation group was lower than that at 2 weeks before operation( P < 0. 05),while the AFC of patients in the control group was higher than that at 2 weeks before operation( P < 0. 05). The AFC at 12 months after operation was significantly higher than that at 3 months after operation in the two groups( P < 0. 05). The AFC of patients in the observation group was significantly lower than that in the control group at 3,12 months after operation( P < 0. 05). Conclusions The serum AMH level of patients with ovarian endometriosis cyst complicated with mesosalpingeal adhesions decreased significantly after cystectomy. It is necessary to monitor the AMH level and strengthen intervention in clinic.
引文
[1]叶丽虹,方雅琴,田国琴,等.腹腔镜卵巢子宫内膜异位囊肿剥除术联合使用GnRH-a对卵巢储备功能的影响[J].现代妇产科进展,2014,23(3):171-174.
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[7]李友云,张丽,邢素娟,等.加味桂枝茯苓汤对多囊卵巢综合征血清抗苗勒管激素及子宫内膜容受性的影响[J].世界中医药,2018,13(12):3035-3038,3042.
[8]陈薪,尹敏娜,叶德盛,等.血清与卵泡液抗苗勒氏管激素对多囊卵巢综合症患者体外受精-胚胎移植临床结果的预测价值[J].南方医科大学学报,2013,33(4):546-549.
[9]张媛,糜媛媛,何晶.知柏地黄丸对卵巢储备功能低下性激素及妊娠的影响及其作用机制研究[J].世界中医药,2018,13(10):2405-2408.
[10] CLARK M,ZIGRAS T,BAYAT L,et al. Minimally invasive nonlaparoscopic ovarian cystectomy:a unique way to approach large ovarian cysts[J]. J Minim Invas Gyn,2015,22(6):S150.
[11]谢秋娴,洪宇,陈婵玉,等.腹腔镜下囊肿剔除术对不同卵巢良性囊肿患者血清抗苗勒管激素水平的影响[J].中国妇幼保健,2013,28(28):4630-4634.
[12] OZAKI R,KUMAKIRI J,TINELLI A,et al. Evaluation of factors predicting diminished ovarian reserve before and after laparoscopic cystectomy for ovarian endometriomas:a prospective cohort study[J]. J Ovarian Res,2016,9(1):1-10.
[13]陈雪兰,陈光元,黄平,等.腹腔镜卵巢子宫内膜异位囊肿剥除术联合亮丙瑞林对卵巢储备功能及生育的影响[J].海南医学,2016,27(16):2638-2640.
[14]周勇,简玉辉,梁朝明,等.腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术对血清抗苗勒管激素水平变化的影响[J].现代妇产科进展,2016,25(2):120-122.
[15]辛玲丽.腹腔镜卵巢子宫内膜异位囊肿剥除术中的卵泡丢失[D].上海:第二军医大学,2013.
[2]何剑芬,胡红波.开腹手术和腹腔镜手术治疗卵巢子宫内膜异位囊肿疗效对比分析[J].河北医学,2014,20(10):1699-1701.
[3]侯丽明,王佳慧.抗苗勒管激素在卵巢子宫内膜异位囊肿患者血清中的表达及临床意义[J].中国综合临床,2017,33(12):1131-1134.
[4]王珂,李宛玲,姜克萍.腹腔镜囊肿剥除术与腹腔镜囊肿电凝术治疗卵巢子宫内膜异位囊肿疗效比较[J].新乡医学院学报,2019,36(3):271-274.
[5] CHEN Y,PEI H,CHANG Y,et al. The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone:a prospective cohort study[J]. J Ovarian Res,2014,7(1):108-115.
[6]袁华,赵绍杰,王家俊.血清抗苗勒氏管激素评价腹腔镜下卵巢囊肿剥除术对卵巢储备功能影响的临床研究[J].中国妇幼保健,2014,29(35):5865-5870.
[7]李友云,张丽,邢素娟,等.加味桂枝茯苓汤对多囊卵巢综合征血清抗苗勒管激素及子宫内膜容受性的影响[J].世界中医药,2018,13(12):3035-3038,3042.
[8]陈薪,尹敏娜,叶德盛,等.血清与卵泡液抗苗勒氏管激素对多囊卵巢综合症患者体外受精-胚胎移植临床结果的预测价值[J].南方医科大学学报,2013,33(4):546-549.
[9]张媛,糜媛媛,何晶.知柏地黄丸对卵巢储备功能低下性激素及妊娠的影响及其作用机制研究[J].世界中医药,2018,13(10):2405-2408.
[10] CLARK M,ZIGRAS T,BAYAT L,et al. Minimally invasive nonlaparoscopic ovarian cystectomy:a unique way to approach large ovarian cysts[J]. J Minim Invas Gyn,2015,22(6):S150.
[11]谢秋娴,洪宇,陈婵玉,等.腹腔镜下囊肿剔除术对不同卵巢良性囊肿患者血清抗苗勒管激素水平的影响[J].中国妇幼保健,2013,28(28):4630-4634.
[12] OZAKI R,KUMAKIRI J,TINELLI A,et al. Evaluation of factors predicting diminished ovarian reserve before and after laparoscopic cystectomy for ovarian endometriomas:a prospective cohort study[J]. J Ovarian Res,2016,9(1):1-10.
[13]陈雪兰,陈光元,黄平,等.腹腔镜卵巢子宫内膜异位囊肿剥除术联合亮丙瑞林对卵巢储备功能及生育的影响[J].海南医学,2016,27(16):2638-2640.
[14]周勇,简玉辉,梁朝明,等.腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术对血清抗苗勒管激素水平变化的影响[J].现代妇产科进展,2016,25(2):120-122.
[15]辛玲丽.腹腔镜卵巢子宫内膜异位囊肿剥除术中的卵泡丢失[D].上海:第二军医大学,2013.