多囊卵巢综合征及卵巢打孔术  

Polycystic Ovarian Syndrome and Laparoscopic Ovarian Drilling

作　　者：TC Li 赵玉婷[2] 

机构地区：[1]首都医科大学附属复兴医院妇产科,100038 [2]首都医科大学附属复兴医院宫腔镜中心,100038

出　　处：《国际生殖健康／计划生育杂志》2017年第3期189-194,共6页Journal of International Reproductive Health/Family Planning

摘　　要：多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是一种内分泌紊乱性疾病,是无排卵性不孕的主要病因。氯米芬(clomifene citrate,CC)是无排卵PCOS的首选一线促排卵治疗。随着腹腔镜手术的发展,腹腔镜下卵巢打孔术(laparoscopic ovarian drilling,LOD)已成为治疗无排卵PCOS广泛应用的微创治疗方式,当CC抵抗时LOD可作为首选促排卵方法。LOD术中需特别强调穿刺针应垂直卵巢,充分冲洗卵巢,预防医源性粘连。PCOS患者LOD术后,卵巢功能、月经及内分泌可得到明显改善。研究显示显著肥胖、雄激素过多症、长时间不孕可能预测LOD抵抗。术前黄体生成激素(LH)高水平LOD术后排卵妊娠的概率更高。LOD较促性腺激素治疗避免了多胎妊娠、卵巢过度刺激综合征(OHSS)等并发症。Polycystic ovarian syndrome is a common endocrine disorder,and the most common cause of anovulatory infertility.In women presenting with anovulation associated with PCOS,clomifene citrate is the standard first line treatment for induction of ovulation.With the development of operative laparoscopy,laparoscopic ovarian drilling（LOD） is wildly used in treatment of anovulation.Patient,who is CC-resistance,can be offered LOD as the preferred second line treatment for ovulation induction.It is important to note that the puncture needle is applied to the ovary at right angle.The ovary is then ample irrigated to minimize adhesion formation.Most of the patients who underwent LOD,the ovarian function,menstruation and endocrine is improved significantly.The study found that marked obesity,marked hyperandrogenism and long duration of infertility seemed to predict resistance to LOD.High preoperative luteinizing hormone concentration in women who ovulated after LOD predict higher probability of pregnancy.LOD appears to offer several advantages over gonadotrophin therapy,like avoiding multiple pregnancies and ovarian hyper-stimulation syndrome.

关 键 词：多囊卵巢综合征 氯米芬 腹腔镜下卵巢打孔术 腹腔镜检查 电外科手术 烧灼术 

分 类 号：R713.6[医药卫生—妇产科学]