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  

Effect of laparoscopic cystectomy on serum anti-mullerian hormone level in patients with diverse benign ovarian cysts

作　　者：谢秋娴[1] 洪宇[2] 陈婵玉[1] 黄韩薇[1] 杨纯[1] 

机构地区：[1]广东省潮州市中心医院妇科,521000 [2]中山大学孙逸仙纪念医院妇产科

出　　处：《中国妇幼保健》2013年第28期4630-4634,共5页Maternal and Child Health Care of China

摘　　要：目的：通过检测手术前后卵巢良性囊肿患者血清抗苗勒管激素（AMH）水平的变化，探讨腹腔镜下囊肿剔除术对卵巢储备功能的影响。方法：回顾性分析2009年3月～2011年3月行腹腔镜下单侧良性卵巢囊肿剔除术148例患者的临床资料，按病理类型分为卵巢巧克力囊肿组（巧囊组）和非巧囊组。术中均行卵巢缝合止血，未予电凝。术前、术后1个月、术后3个月、术后6个月行Kupperman评分，并抽血检测促卵泡激素（FSH）、黄体生成素（LH）、雌二醇（E2）及AMH水平，术后6个月行阴道或直肠B超测卵巢体积（V0）、卵巢间质动脉收缩期峰值（PSV）、窦卵泡数（AFC）。结果：手术前及手术后各随访时段两组患者Kupperman评分、FSH、LH及E，水平无统计学差异（P〉0．05）；术前非巧囊组AMH水平明显高于巧囊组（P〈0．05），术后1个月两组患者AMH水平均较术前明显下降，术后3个月和6个月均有所恢复，其中巧囊组下降更为明显，术后6个月AMH水平仅恢复至术前约80％左右的水平；两组在术后6个月超声检查中，手术侧及正常侧的Vo、PSV和AFC均无统计学差异（P〉0．05）；术后囊肿标本病理检查提示巧囊组标本中囊壁周边可见正常卵巢组织的阳性率明显高于非巧囊组（41．67％vs．10．61％，P〈0．05）。结论：腹腔镜下卵巢囊肿剔除术对卵巢囊肿患者的卵巢储备功能会产生不同程度的近期损害，与病理类型有关，对巧克力囊肿患者的影响尤为明显，AMH是评价其影响的可选指标。Objective： To evaluate the effect of laparoscopic cystectomy on ovarian reserve in patients with diverse benign ovarian cysts by investigating the serum anti -mullerian hormone （AMH） level before and after operation. Methods： A total of 148 patients who un- derwent laparoseopic eysteetomy due to unilateral ovarian cyst from March 2009 to March 2011 were recruited in this retrospective analysis. All patients were divided into Endometrioma group and Non - endometrioma group by pathological types. Surgery underwent including ovari- an hemostasis, but not electric coagulation . Kupperman index was recorded, and serum FSH, LH, E2 and AMH levels were measured be- fore operation and at 1 month, 3 months and 6 months follow - up visit afterwards. Ovarian volume （Vo）, the peak systolic velocity （PSV） and antral follicle counts （AFC） were determined at 6 - month postoperative follow - up by ultrasonography. Results： There were no signifi- cant differences between two groups in terms of Kupperman index, serum FSH, LH and E2 levels before operation and at each follow - up time. Serum AMH level was found to be higher in Non - endometrioma group than that in Endometrioma group before operation. AMH more markedly declined at postoperative 1 month, Endometrioma group was lower than Non - endometrioma group, and was recovered to a fewer extent of the preoperative level after 3 months and 6 months postoperatively. The AMH level recovered to only about 80% of the preoperative level at 6 months postoperatively. At 6 months postoperatively, Vo, PSV and AFC were found to be similar between two groups. Normal o- varian tissues were found to be more common beside cyst walls of Endometrioma than Non -endometrioma （41.67% vs. 10. 61% , P 〈 O. 05 ） . Conclusion： Laparoscopic cystectorny could impair the ovarian reserve to some extent in patients with ovarian cysts in the immediate future and the effects could be related with ihe pathological patterns. The influence seems to be more obvious in patients with end

关 键 词：腹腔镜 卵巢囊肿剔除术 抗苗勒管激素 卵巢储备 

分 类 号：R713.6[医药卫生—妇产科学]