腹腔镜下卵巢打孔术联合来曲唑治疗难治性多囊卵巢综合征对患者卵巢储备功能及卵巢间质血流动力学的影响  

Effects of laparoscopic ovarian drilling combined with letrozole on ovarian reserving function and ovarian stroma hemodynamics in patients with refractory polycystic ovary syndrome

作　　者：赵晓丹 郑晓红 许晓立 李慧 郭影 苑辉 郭钰英 戴芳芳 郑波 ZHAO Xiaodan;ZHENG Xiaohong;XU Xiaoli(Reproductive Center,Xingtai Infertility Sterility Special Hospital,Hebei,Xingtai 054001,China)

机构地区：[1]河北省邢台不孕不育专科医院生殖中心,054001

出　　处：《河北医药》2020年第17期2610-2613,共4页Hebei Medical Journal

基　　金：河北省中医药管理局科研计划(编号:2020567)。

摘　　要：目的观察腹腔镜下卵巢打孔术联合来曲唑治疗难治性多囊卵巢综合征(PCOS)对患者卵巢储备功能及卵巢间质血流动力学的影响。方法78例难治性PCOS不孕患者按照随机数字表法分为观察组和对照组,每组39例。对照组行腹腔镜下卵巢打孔术治疗,观察组行腹腔镜下卵巢打孔术+来曲唑治疗。比较2组血清黄体生成素(LH)、卵泡刺激素(FSH)、雄激素(T)、雌二醇(E2)水平及垂体泌乳素(PRL)水平、抗苗勒管激素(AMH)水平。B超检测卵巢基质血流动力学参数,包括搏动指数(PI)、基质血流收缩期峰速(PSV)及舒张期最低血流(EDV);比较2组治疗周期内排卵率及随访6个月的受孕率及妊娠结局情况。结果治疗3个月后,2组患者的FSH水平均较治疗前升高,LH、T、LH/FSH及AMH降低,差异有统计学意义(P<0.05),PRL及E2水平差异无统计学意义(P>0.05)。2组治疗前各激素水平及AMH差异无统计学意义(P<0.05),治疗后观察组FSH水平高于对照组,LH、T、LH/FSH及AMH低于对照组,差异有统计学意义(P<0.05)。治疗后,2组卵巢体积缩小,窦卵泡数减少,卵巢基质血流动力学PSV、RI及EDV降低,组内比较差异均有统计学意义(P<0.05),组间比较差异有统计学意义(P<0.05)。2组3个月内月经正常率差异无统计学意义(P>0.05),观察组排卵率高于对照组(P<0.05),观察组6个月内妊娠率高于对照组(P<0.05),但流产率低于对照组(P<0.05)。结论腹腔镜下卵巢打孔术联合来曲唑治疗难治性PCOS能有效改善患者卵储备功能及卵巢间质血流动力学的影响,提高妊娠率。Objective To investigate the effects of laparoscopic ovarian drilling combined with letrozole on ovarian reserving function and ovarian stroma hemodynamics in patients with refractory polycystic ovary syndrome(PCOS).Methods 78 patients with refractory PCOS infertility were divided into observation group and control group according to random number table method,with 39 cases in each group.The patients in control group were treated by laparoscopic ovarian drilling,however,the patients in observation group were treated by laparoscopic ovarian drilling combined with letrozole.The serum levels of luteinizing hormone(LH),follicle stimulating hormone(FSH),androgen(T),estradiol(E2),pituitary prolactin(PRL),and Müllerian hormone(AMH)were observed and compared between the two groups.And B-ultrasound was used to detect the ovarian matrix hemodynamic parameters,including pulsatility index(PI),systolic peak velocity(PSV)and diastolic minimum blood flow(EDV),moreover,the ovulation rate during treatment,pregnancy rate after 6-month follow up and pregnancy outcomes were observed and compared between the two groups.Results After 3-month treatment,the FSH levels in both groups were significantly higher than those before treatment,however,the levels of LH,T,LH/FSH and AMH were significantly decreased(P<0.05),and there were no significant differences in the levels of PRL and E2(P>0.05).Before treatment there were no significant differences in the levels of hormones and AMH between the two groups(P<0.05).After treatment the FSH levels in observation group were significantly higher than those in control group,but the levels of LH,T,LH/FSH and AMH were significantly lower than those in control group(P<0.05).After treatment,the ovarian volume in both groups was decreased,the number of antral follicles was decreased,and the ovarian stromal hemodynamics indexes including PSV,RI and EDV were decreased,there were significant differences in intragroup comparison and comparison between the two groups(P<0.05).There was no significant differen

关 键 词：难治性多囊卵巢综合征 腹腔镜下卵巢打孔术 来曲唑 卵巢储备功能 

分 类 号：R711.75[医药卫生—妇产科学]