腹腔镜卵巢组织切除术中获取未成熟卵在生育力保存中的应用  

Application of immature oocytes collection during laparoscopic ovarian tissue resection in fertility preservation

作　　者：宋雪凌[1] 严杰[1] 张文[1] 杨硕[1] 张佳佳[1] 杨蕊[1] 杨艳[1] 马彩虹[1] 李蓉[1] 乔杰[1] Song Xueling;Yan Jie;Zhang Wen;Yang Shuo;Zhang Jiajia;Yang Rui;Yang Yan;Ma Caihong;Li Rong;Qiao Jie(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,National Clinical Research Center for Obstetrics and Gynecology(Peking University Third Hospital),Key Laboratory of Assisted Reproduction(Peking University),Ministry of Education/Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology/Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest,Chinese Academy of Medical Sciences,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科生殖医学中心、国家妇产疾病临床医学研究中心(北京大学第三医院)、辅助生殖教育部重点实验室(北京大学)、北京市生殖内分泌与辅助生殖技术重点实验室、中国医学科学院卵成熟障碍创新单元,北京100191

出　　处：《中华生殖与避孕杂志》2023年第2期134-139,共6页Chinese Journal of Reproduction and Contraception

基　　金：国家重点研发计划(2022YFC2703000);中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-001)。

摘　　要：目的探索女性肿瘤患者在腹腔镜卵巢皮质切除术中获取未成熟卵体外成熟后(in vitro maturation,IVM)冷冻卵母细胞保存生育力的可行性及有效性。方法回顾分析2015年11月至2022年4月期间于北京大学第三医院妇产科生殖医学中心行腹腔镜下卵巢皮质切除术的22例肿瘤患者的一般资料、手术方法及术后随访资料。研究组纳入腹腔镜术中同时获取未成熟卵IVM的患者(n=14);对照组纳入仅行皮质切除的患者(n=8)。分析两组患者的手术时间、出血量、冻存皮质数量等数据,评估该方法的应用价值及安全性。研究组根据取卵方式不同分为两个亚组,经阴道取卵亚组(n=10)及经腹腔镜取卵亚组(n=4),分析两亚组患者的手术时间、获卵数、冻存皮质数量等数据,评估不同获卵方式的效率。全部22例患者术后每年进行随访,询问肿瘤治疗情况、月经情况,条件允许者返院复查盆腔超声、性激素水平测定,记录这些患者肿瘤治疗后的卵巢功能并予以适应证范围内的激素替代治疗(hormone replacement therapy,HRT)。结果研究组和对照组患者年龄、患病时间、抗苗勒管激素(anti-Müllerian hormone,AMH)水平、冻存皮质数量之间差异均无统计学意义(均P>0.05),但研究组的基础窦卵泡数(19.71±6.04)、手术时间[(68.07±17.35)min]、出血量[9.0(5.0,10.5)mL]高于对照组[9.25±3.15,P<0.001;(44.25±16.97)min,P=0.005;3.5(2.0,5.0)mL,P=0.001],差异均具有统计学意义。14例取卵患者中,经阴道取卵亚组的获卵数[15.5(11.0,21.0)个]及年龄[(27.00±2.94)岁]显著高于经腹腔镜取卵亚组[4.0(0.8,10.3)个,P=0.028;(15.75±2.22)岁,P<0.001],两亚组间患者窦卵泡数、手术时间、冻存皮质数量差异均无统计学意义(均P>0.05)。接受造血干细胞移植(hematopoietic stem cell transplantation,HSCT)的7例患者出仓后均出现闭经,疾病缓解后予以HRT,身体发育及生活质量得以维持及改善。结论年轻肿Objective To explore the feasibility and effective methods of obtaining immature oocytes during laparoscopic ovarian tissue resection in female tumor patients,aiming at oocytes freezing matured in vitro for fertility preservation.Methods Retrospective analysis was made on the general data,surgical methods and postoperative follow-up data of 22 tumor patients who underwent laparoscopic ovarian tissue resection at the Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital from November 2015 to April 2022.The study group included 14 patients who simultaneously obtained in vitro maturation(IVM)of immature eggs during laparoscopy.Control group included 8 patients who only underwent cortical resection.The operation time,the amount of bleeding,the number of frozen cortex and other data of the two groups were analyzed to evaluate the application value and safety of this method.Furtherly,the study group was divided into two subgroups,the transvaginal egg retrieval subgroup(10 patients)and the translaparoscopic egg retrieval subgroup(4 patients),according to the method of different methods used for egg retrieval.The time of surgery,the number of eggs obtained and the number of frozen cortices were analyzed in both subgroups to evaluate the efficiency of the different methods of egg retrieval.All 22 patients were followed up annually after surgery,analyzing the information of tumor treatment,menstrual status,and if possible,pelvic ultrasound and sex hormone levels,recording ovarian function after tumor treatment in these patients and providing hormone replacement therapy(HRT)within the indications.Results There were no statistically significant differences between the study group and control group in terms of age,duration of disease,anti-Müllerian hormone(AMH)level,and the number of frozen cortices.But the number of basal sinus follicles(19.71±6.04),procedure time[(68.07±17.35)min],and bleeding volume[9.0(5.0,10.5)mL]in the study group were higher than those in control g

关 键 词：激素替代疗法 生育力保存 体外成熟 卵巢皮质切除 

分 类 号：R737.31[医药卫生—肿瘤]