腹腔镜卵巢打孔联合经阴道未成熟卵泡穿刺术治疗难治性多囊卵巢综合征的疗效观察  

Effects of Laparoscopic Ovarian Drilling Combined with Transvaginal Immature Follicle Aspiration on Refractory Polycystic Ovary Syndrome

作　　者：宋雪凌[1] 马彩虹[1] 李蓉[1] 杨蕊[1] 张佳佳[1] 杨硕[1] 杨艳[1] 卢翠玲[1] 乔杰[1] 

机构地区：[1]北京大学第三医院生殖医学中心,北京100083

出　　处：《中国微创外科杂志》2017年第5期388-392,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然科学基金海外及港澳合作基金(31429004);院内临床重点支持项目(Y67437-10)

摘　　要：目的评估难治性多囊卵巢综合征(polycystic ovary syndrome,PCOS)行腹腔镜卵巢打孔(laparoscopic ovarian drilling,LOD)联合经阴道未成熟卵泡穿刺术(immature follicle aspiration,IMFA)的疗效。方法 2014年9月~2016年7月,共纳入拟行LOD的难治性PCOS 124例。术前依据患者的意愿,愿意LOD术中同时行IMFA获取未成熟卵者行LOD+IMFA手术,共83例,不愿意同时获卵者仅行LOD手术,共41例。比较2组性激素水平包括促黄体生成素(LH)、雄烯二酮(A)、游离雄激素指数(FAI)、抗缪勒管激素(AMH)等。随访6~12个月,观察自然排卵恢复、促排卵治疗效果及妊娠情况。结果 2组术后第1次月经期LH、A、AMH均比术前显著下降(P<0.05),2组之间比较差异无显著性(P>0.05)。恢复自然排卵的比例LOD+IMFA组39.8%(33/83),LOD组34.1%(14/41),2组差异无显著性(χ~2=0.367,P=0.544)。对未恢复排卵者进行促排卵治疗,LOD+IMFA组排卵率[78.0%(39/50)]显著高于LOD组[37.0%(10/27),χ~2=12.713,P=0.000]。2组临床妊娠率差异无显著性[44.6%(29/65)vs.32.3%(10/31),χ~2=1.329,P=0.249]。LOD+IMFA组98.8%(82/83)获得成熟卵。结论 LOD+IMFA治疗难治性PCOS安全有效,术中同时获得未成熟卵为患者进行生育力储备。Objective To observe the changes and effects of laparoscopic ovarian drilling （LOD） combined with transvaginal immature follicle aspiration （IMFA） on patients with refractory polycystic ovary syndrome （PCOS）. Methods A total of 124 patients with refractory PCOS from September 2014 to July 2016 were recruited in this study. According to patients＇ consents prior to the surgery, 83 patients who preferred to receive ultrasound guided IMFA followed by LOD were enrolled in LOD ＋ IMFA group, while 41 patients who refused to take IMFA were recruited into the LOD group, receiving laparoscopy and ovarian drilling only. Serum hormone levels, including luteinizing hormone （LH） , androstenedione （A） , free androgen index （FAI） and anti-mullerian hormone （AMH）, were evaluated before surgeries. In the following 6 -12 months, spontaneous resumption of menstruation, ovulation- stimulation treatment effects, and pregnancy rates were monitored in the two groups. Results Serum levels of LH, A, AMH in both groups were decreased significantly after surgeries compared to the levels before surgeries （ P 〈 0.05 ） , and no significant differences were found between the two groups（P 〉 0.05）. There was no significant difference in the rates of resumption of menstruation between the two groups [39. 8% （33/83） in LOD ＋ IMFA group, and 34. 1% （14/41） in LOD group, respectively, X2 =0. 367, P = 0. 5441 ] However, after ovulation induction treatment, the ovulation rate in LOD ＋ IMFA group [ 78.0% （39/50） ] was significantly higher than that in LOD group [ 37.0% （ 10/27 ） , X2 = 12. 713, P = 0. 000 ]. The pregnancy rate had no significant difference between the two groups [44.6% （29/65） vs. 32.3% （10/31）,X2 =1.329, P=0.249]. InLOD＋IMFA group, 98.8% （82/83） patients acquired mature oocytes. Conclusions LOD ＋ IMFA treatment for refractory PCOS is safe and efficient. The immature ooeytes obtained in the surgery can be stored for patients＇ fertility preservation.

关 键 词：多囊卵巢综合征 卵巢打孔术 未成熟卵穿刺术 

分 类 号：R713.6[医药卫生—妇产科学]