抗苗勒氏管激素评价妇科腔镜手术对卵巢功能影响  

Effect of Anti-müllerian Hormone on Gynecological Laparoscopic Surgery for Ovarian Function

作　　者：陈莉[1] 邓亚丽[1] 

机构地区：[1]湖北省中医院妇产科,湖北武汉430073

出　　处：《中国继续医学教育》2018年第1期61-64,共4页China Continuing Medical Education

摘　　要：目的用血清抗苗勒氏管激素(AMH)及血清基础内分泌激素评价腹腔镜下卵巢有创手术对卵巢储备功能的影响。方法选择我院2014年10月—2016年9月行腹腔镜下卵巢囊肿手术住院患者62例。年龄20~35岁;测定各研究对象术前、术后1个月和术后6个月血清AMH、FSH、LH、E_2水平。结果腹腔镜下卵巢子宫内膜异位囊肿剥除术后1个月,血清AMH水平较术前均下降,P<0.001,且术后6个月血清AMH水平低于术后1月,P<0.001。术后1个月与术前相比较,双侧卵巢子宫内膜囊肿组,血清AMH平均下降54%,单侧组血清AMH平均下降41%,两组血清AMH下降百分率对比,差异有统计学意义,P<0.05;最大卵巢子宫内膜异位囊肿直径>5 cm剥除术后,血清AMH水平下降百分率大于最大卵巢囊肿直径<5 cm的剥除术后,P<0.01。血清FSH水平在术后1个月较术前升高,P<0.05,但术后6个月与术前相比,差异无统计学意义,P>0.05。手术前后各时间点FSH/LH、E_2对比,差异无统计学意义,P>0.05。结论腹腔镜下卵巢子宫内膜异位囊肿剥除术可致术后卵巢储备能力降低,且卵巢囊肿越大,剥除后对卵巢储备影响越大,双侧较单侧对卵巢储备功能的影响更大。对于卵巢有创手术后评价卵巢储备功能,血清AMH较血清基础内分泌激素更敏感。Objective To evaluate the effect of laparoscopic ovarian invasive surgery on ovarian reserve function with serum anti-müllerian hormone （AMH） and serum basal endocrine hormone. Methods A total of 62 patients with ovarian endometriosis were enrolled of laparoscopic ovarian cystectomy from October 2014 to September 2016 in our hospital. They were aged from 20 to 35 years old. The levels of serum AMH, FSH, LH and E2 were measured before, 1 month and 6 months after operation.Results Compared with preoperative laparotomy, the level of serum AMH was signifcantly decreased （P〈0.001） at 1 month after laparoscopic ovarian endometriosis, and the serum AMH level of 6 months after operation was significantly lower than that of 1 month after operation. （P〈0.001）. Compared with preoperative laparotomy, serum AMH decreased by 54% on the bilateral ovarian endometrial cyst group and 41% in the unilateral group, and the percentage of AMH decreased in the two groups was statistically signifcant （P〈0.05）. The percentage of serum AMH levels of the largest ovarian cysts with diameter〉5 cm was signifcantly higher than that of the largest ovarian cysts with diameter〈5 cm（P〈0.01）. The levels of Serum FSH at 1 month after operation were signifcantly higher than those before operation （P〈0.05）,but there was no signifcant diference in serum FSH level between 6 months after operation and before operation（P〉 0.05）.There was no signifcant diference in FSH / LH and E2 at all time points before and after operation （P〉0.05）. Conclusion Laparoscopic ovarian endometriotic cystectomy can reduce the ovarian reserve after operation, especially the greater the ovarian cyst, the greater the efect on the ovarian reserve after stripping, the bilateral side of the ovarian endometrium ectopic cystectomy has a greater effect on ovarian reserve function. For ovarian invasive surgery to evaluate the ovarian reserve function, serum AMH is more sensitive than the serum-based endocrine hormones.

关 键 词：抗苗勒氏管激素 卵巢储备能力 卵巢囊肿剥除术 

分 类 号：R711[医药卫生—妇产科学]