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目的评估腹腔镜下卵巢子宫内膜异位症(内异症)囊肿剥除术前使用亮丙瑞林治疗对卵巢储备功能的保护效果。方法选取2012年6月-2014年6月间该院收治的卵巢内异症囊肿患者128例,按照病案号的单双号将入选患者分为A、B组,每组各69例。A组患者在给予亮丙瑞林治疗2个周期后行腹腔镜手术,其中单侧囊肿(A1组)40例,双侧囊肿(A2组)29例。B组患者直接行腹腔镜手术,其中单侧囊肿(B1组)43例,双侧囊肿(B2组)26例。记录各组患者手术及术后情况,检测术前和术后6个月时患者血清黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)水平,阴道超声检测卵巢体积、窦卵泡数(AFC)。结果 A2组患者的手术时间、术中出血量均明显低于B2组,差异有统计学意义(t值分别为5.930、7.294,均P<0.05);单侧卵巢内异症囊肿两组间差异均无统计学意义(t值分别为0.364、0.559、0.221,均P>0.05)。双侧卵巢内异症囊肿患者术后FSH水平明显高于术前,E_2水平明显低于术前,差异有统计学意义(t值分别为6.691、8.336,均P<0.05);B2组患者FSH水平明显高于A2组,差异有统计学意义(t=7.006,P<0.05)。单侧卵巢内异症囊肿患者手术前后LH、FSH、E_2水平之间差异均无统计学意义(t值分别为0.336、0.925、1.006,均P>0.05)。B2组患者术后AFC、卵巢体积均明显小于A2组,差异有统计学意义(t值分别为9.331、6.527,均P<0.05);单侧卵巢内异症囊肿患者囊肿侧AFC、卵巢体积明显小于正常侧,差异有统计学意义(t值分别为5.992、6.381,均P<0.05)。结论腹腔镜下卵巢内异症囊肿剥除术可影响卵巢储备功能,以双侧囊肿更明显,术前给予亮丙瑞林治疗可有效减轻手术对卵巢储备功能的影响。
Objective To evaluate the protective effect of leuprolide on ovarian reserve function in laparoscopic ovarian endometriosis (endometriosis) cyst excision. Methods From June 2012 to June 2014, 128 cases of cyst in ovarian endometriosis admitted from June 2012 to June 2014 were selected and divided into group A and group B according to single and double numbers of case number. There were 69 cases in each group. In group A, laparoscopic surgery was performed after 2 cycles of leuprolide, including 40 unilateral cysts (group A1) and 29 bilateral cysts (group A2). Patients in group B underwent laparoscopic surgery directly, including 43 unilateral cysts (group B1) and 26 bilateral cysts (group B2). The operation and postoperative condition of the patients in each group were recorded. The levels of serum LH, FSH and E2 were measured before and 6 months after operation. The ovarian volume, Antral Follicles (AFC). Results The operation time and intraoperative blood loss in group A2 were significantly lower than those in group B2 (t = 5.930, 7.294, respectively, all P <0.05). The difference between the two groups in unilateral ovarian endometriosis No significant difference (t = 0.364,0.559,0.221, all P> 0.05). The postoperative FSH levels in patients with bilateral ovarian cyst were significantly higher than those before operation, and the E_2 levels were significantly lower than those before operation (t = 6.691 and 8.336, respectively, P <0.05). The FSH The level was significantly higher than A2 group, the difference was statistically significant (t = 7.006, P <0.05). There was no significant difference in the levels of LH, FSH and E_2 in patients with unilateral ovarian cyst before and after operation (t = 0.336, 0.925, 1.006, all P> 0.05). The postoperative AFC and ovarian volume in group B2 were significantly lower than those in group A2 (t = 9.331 and 6.527, respectively, all P <0.05). The volume of AFC and ovary in cyst of unilateral ovarian endometriosis Less than the normal side, the difference was statistically significant (t values were 5.992,6.381, both P <0.05). Conclusion Laparoscopic cyst extirpation of ovarian endometriosis can affect ovarian reserve function, with bilateral cysts more obvious. Preoperative administration of leuprolide can effectively reduce the effect of surgery on ovarian reserve.