腹腔镜手术联合GnRHa治疗卵巢巧克力囊肿伴不孕的临床效果观察
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摘要
目的探讨卵巢巧克力囊肿合并不孕患者应用腹腔镜手术联合促性腺激素释放激素激动剂(GnRHa)治疗的临床疗效。方法回顾性分析2014年1月至2016年10月期间在茂名化州市中医院妇产科住院治疗的125例卵巢巧克力囊肿合并不孕症患者的临床资料,根据治疗方法的不同,将单纯接受腹腔镜手术治疗的75例患者纳入对照组,腹腔镜手术联合GnRHa治疗的50例患者纳入观察组,比较两组患者术前及术后3个月血清卵泡刺激素(FSH)、雌激素(E2)、黄体生成素(LH)的水平。同时,记录并比较两组患者术后两年内的复发及妊娠情况。结果术后3个月,观察组患者的血清FSH、LH、E2水平分别为(4.67±1.34) mIU/mL、(10.08±2.23) mIU/mL、(48.29±14.31) pmol/L,明显低于对照组的(6.53±1.57) m IU/mL、(13.28±2.75) m IU/mL、(69.64±18.46) pmol/L,差异均有统计学意义(P<0.05);术后随访2年,观察组患者的妊娠率为42.0%,明显高于对照组的24.0%,复发率为6.0%,明显低于对照组的17.3%,差异均有统计学意义(P<0.05)。结论应用腹腔镜手术联合GnRHa治疗卵巢巧克力囊肿合并不孕,可以有效降低患者体内雌激素水平,有效抑制术后的复发,且可以提高患者的妊娠率。
Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin releasing hormone agonists(GnRHa) in the treatment of ovarian chocolate cysts associated infertility. Methods The clinical data 125 patients with ovarian chocolate cysts associated infertility, who admitted to Department of Obstetrics and Gynecology, Maoming Huazhou Hospital of Traditional Chinese Medicine from January 2014 to October 2016,were retrospectively analyzed. According to the different treatment methods, 75 patients who received laparoscopic surgery alone were included into the control group, and 50 patients who received laparoscopic surgery combined with GnRHa were included into the observation group. The serum follicles of the two groups before and after 3 months were compared. The levels of stimulating hormone(FSH), estrogen(E_2), and luteinizing hormone(LH) was detected at the same time, and the recurrence and pregnancy of the two groups within two years after operation were recorded and compared. Results Three months after operation, the levels of serum FSH, LH and E_2 in the observation group were(4.67±1.34) mIU/mL,(10.08 ±2.23) mIU/mL,(48.29±14.31) pmol/L, respectively, which were significantly lower than(6.53±1.57) mIU/mL,(13.28±2.75) m IU/mL,(69.64±18.46) pmol/L in the control group(all P<0.05). After 2 years of follow-up, the pregnancy rate(42.0%) in the observation group was significantly higher than that in the control group(24.0%); the recurrence rate(6.0%) in the observation group was significantly lower than that in the control group(17.3%); the differences were ststistically significant(P<0.05). Conclusion In the treatment of ovarian chocolate cysts associated infertility, laparoscopic surgery combined with GnRHa can effectively reduce the level of estrogen in patients,effectively inhibit the recurrence after surgery, and improve the pregnancy rate of patients.
Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin releasing hormone agonists(GnRHa) in the treatment of ovarian chocolate cysts associated infertility. Methods The clinical data 125 patients with ovarian chocolate cysts associated infertility, who admitted to Department of Obstetrics and Gynecology, Maoming Huazhou Hospital of Traditional Chinese Medicine from January 2014 to October 2016,were retrospectively analyzed. According to the different treatment methods, 75 patients who received laparoscopic surgery alone were included into the control group, and 50 patients who received laparoscopic surgery combined with GnRHa were included into the observation group. The serum follicles of the two groups before and after 3 months were compared. The levels of stimulating hormone(FSH), estrogen(E_2), and luteinizing hormone(LH) was detected at the same time, and the recurrence and pregnancy of the two groups within two years after operation were recorded and compared. Results Three months after operation, the levels of serum FSH, LH and E_2 in the observation group were(4.67±1.34) mIU/mL,(10.08 ±2.23) mIU/mL,(48.29±14.31) pmol/L, respectively, which were significantly lower than(6.53±1.57) mIU/mL,(13.28±2.75) m IU/mL,(69.64±18.46) pmol/L in the control group(all P<0.05). After 2 years of follow-up, the pregnancy rate(42.0%) in the observation group was significantly higher than that in the control group(24.0%); the recurrence rate(6.0%) in the observation group was significantly lower than that in the control group(17.3%); the differences were ststistically significant(P<0.05). Conclusion In the treatment of ovarian chocolate cysts associated infertility, laparoscopic surgery combined with GnRHa can effectively reduce the level of estrogen in patients,effectively inhibit the recurrence after surgery, and improve the pregnancy rate of patients.
引文
[1]陈玉清,裴慧慧,常亚杰.卵巢巧克力囊肿对卵巢储备功能的影响分析[J].中山大学学报(医学科学版), 2014, 35(5):744-747.
[2]吴敏君,金皖玲,钱芳.孤啡肽在子宫内膜异位症患者在位内膜及异位内膜的表达及与患者痛经程度的关系[J].医学临床研究,2014, 31(12):2346-2348.
[3]刘媛媛,赵仁峰.腹腔镜下卵巢巧克力囊肿剥除术不同止血方法对卵巢储备功能的影响[J].广西医科大学学报, 2015, 32(1):87-89.
[4]赵有仙,卢燕,刘艳.腹腔镜手术联合药物治疗卵巢巧克力囊肿近期疗效观察[J].安徽医学, 2015, 36(3):316-318.
[5] SENAPATI S, BARNHART K. Managing endometriosis associated infertility[J]. Clin Obstet Gynecol, 2011, 54(4):720.
[6]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.
[7]王岩,孙鲲,黄建新,等.经阴道超声在异位妊娠与卵巢黄体破裂鉴别诊断中的应用价值[J].中国妇幼保健, 2013, 28(33):5556-5558.
[8]张素仙,顾涛,周红林,等.卵巢巧克力囊肿自发破裂致急腹症临床特点分析[J].昆明医科大学学报, 2013, 34(4):68-71.
[9]刘芳,张白云,谢建端,等.超声引导介入治疗卵巢巧克力囊肿51例临床分析[J].中国现代医学杂志, 2015, 25(34):105-108.
[10]管春风,赵卫东.腹腔镜卵巢巧克力囊肿剔除术中不同止血方式对卵巢功能的影响[J].山东医药, 2013, 53(15):75-77.
[11]熊巍,孙大为,张俊吉,等经脐单孔腹腔镜与传统三孔腹腔镜卵巢囊肿剔除术的对比研究[J].中华妇产科杂志, 2014, 49(3):176-178.
[12]王粉玲,何莉茹,杜娟,等.腹腔镜与开腹卵巢囊肿剔除术治疗效果及其对卵巢功能影响的研究[J].中国医刊, 2016, 51(2):71-74.
[13]郭欢欢,申爱荣,徐胜男,等.腹腔镜卵巢子宫内膜异位囊肿保守性手术后复发的相关因素分析[J].中南大学学报(医学版), 2016, 41(4):405-410.
[14]吴淑芳,韦迪霞. GnRHa在保守性手术后子宫内膜异位症患者中应用的系统评价[J].海南医学, 2014, 25(8):1127-1129.
[15]陈小琳,金平,汤惠茹,等. GnRHa对Ⅰ~Ⅱ期子宫内膜异位症伴不孕患者妊娠结局的影响分析[J].齐齐哈尔医学院学报, 2015, 36(4):489-490.
[16]岳军,杨荣秀.腹腔镜联合药物治疗中重度子宫内膜异位症合并不孕症的临床分析[J].腹腔镜外科杂志, 2006, 11(5):397-399.
[2]吴敏君,金皖玲,钱芳.孤啡肽在子宫内膜异位症患者在位内膜及异位内膜的表达及与患者痛经程度的关系[J].医学临床研究,2014, 31(12):2346-2348.
[3]刘媛媛,赵仁峰.腹腔镜下卵巢巧克力囊肿剥除术不同止血方法对卵巢储备功能的影响[J].广西医科大学学报, 2015, 32(1):87-89.
[4]赵有仙,卢燕,刘艳.腹腔镜手术联合药物治疗卵巢巧克力囊肿近期疗效观察[J].安徽医学, 2015, 36(3):316-318.
[5] SENAPATI S, BARNHART K. Managing endometriosis associated infertility[J]. Clin Obstet Gynecol, 2011, 54(4):720.
[6]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.
[7]王岩,孙鲲,黄建新,等.经阴道超声在异位妊娠与卵巢黄体破裂鉴别诊断中的应用价值[J].中国妇幼保健, 2013, 28(33):5556-5558.
[8]张素仙,顾涛,周红林,等.卵巢巧克力囊肿自发破裂致急腹症临床特点分析[J].昆明医科大学学报, 2013, 34(4):68-71.
[9]刘芳,张白云,谢建端,等.超声引导介入治疗卵巢巧克力囊肿51例临床分析[J].中国现代医学杂志, 2015, 25(34):105-108.
[10]管春风,赵卫东.腹腔镜卵巢巧克力囊肿剔除术中不同止血方式对卵巢功能的影响[J].山东医药, 2013, 53(15):75-77.
[11]熊巍,孙大为,张俊吉,等经脐单孔腹腔镜与传统三孔腹腔镜卵巢囊肿剔除术的对比研究[J].中华妇产科杂志, 2014, 49(3):176-178.
[12]王粉玲,何莉茹,杜娟,等.腹腔镜与开腹卵巢囊肿剔除术治疗效果及其对卵巢功能影响的研究[J].中国医刊, 2016, 51(2):71-74.
[13]郭欢欢,申爱荣,徐胜男,等.腹腔镜卵巢子宫内膜异位囊肿保守性手术后复发的相关因素分析[J].中南大学学报(医学版), 2016, 41(4):405-410.
[14]吴淑芳,韦迪霞. GnRHa在保守性手术后子宫内膜异位症患者中应用的系统评价[J].海南医学, 2014, 25(8):1127-1129.
[15]陈小琳,金平,汤惠茹,等. GnRHa对Ⅰ~Ⅱ期子宫内膜异位症伴不孕患者妊娠结局的影响分析[J].齐齐哈尔医学院学报, 2015, 36(4):489-490.
[16]岳军,杨荣秀.腹腔镜联合药物治疗中重度子宫内膜异位症合并不孕症的临床分析[J].腹腔镜外科杂志, 2006, 11(5):397-399.