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目的评价经阴道超声引导卵巢内激光治疗后多囊卵巢综合征(PCOS)患者血激素水平的变化和临床效果。方法23例对克罗米芬和促性腺激素诱发排卵治疗无反应,或出现卵巢过度刺激综合征的PCOS不孕患者,在超声引导下行经阴道卵巢间质YAG激光治疗。长穿刺针送入400μm光纤,每侧卵巢内激光凝固3~4个点,观察术后半年内每个病例的血清黄体生成素(LH)/卵泡刺激素(FSH)比值、睾酮、小卵泡数目的变化及自发排卵率和妊娠率。结果治疗23例,随访22例,其中19例术后发生自发规律排卵和月经,自发排卵率86.4%(19/22)。术后2、4、6个月平均血清LH和睾酮水平分别为(4.62±1.47)I U/L和(2.46±1.63)nmol/L,显著低于术前的(13.89±3.62)I U/L和(5.37±3.09)nmol/L(P<0.001);平均LH/FSH值为0.87±0.19,显著低于术前的2.78±1.21(P<0.001);单侧卵巢内小卵泡数为(15.85±3.97)个,显著少于术前的(25.35±5.76)个(P<0.001)。共有8例妊娠,累计妊娠率36.3%(8/22)。结论超声引导经阴道卵巢间质激光治疗能改善PCOS患者血激素紊乱状态,是治疗PCOS排卵障碍的有效方法。
Objective To evaluate the changes and clinical effects of transvaginal ultrasound in the treatment of ovarian laser in patients with polycystic ovary syndrome (PCOS). Methods Twenty-three cases of PCOS infertility who did not respond to clomiphene and gonadotropin-induced ovulation or ovarian hyperstimulation syndrome were treated with ultrasound-guided transvaginal ovarian interstitial YAG laser. Long puncture needles were delivered to 400μm optical fibers, and each ovary was laser-coagulated for 3 to 4 points. The LH / FSH ratio, testosterone and follicle number in each case within 6 months after operation were observed. Changes and spontaneous ovulation and pregnancy rates. Results Twenty-three cases were followed up, of which 22 cases were followed up. Among them, 19 cases had spontaneous regular ovulation and menstruation. The rate of spontaneous ovulation was 86.4% (19/22). The mean LH and testosterone levels at 2, 4 and 6 months after operation were (4.62 ± 1.47) IU / L and (2.46 ± 1.63) nmol / L, respectively, which were significantly lower than those of 13.89 ± 3.62 IU / L and (5.37 ± 3.09) nmol / L (P <0.001). The average LH / FSH value was 0.87 ± 0.19, which was significantly lower than preoperative 2.78 ± 1.21 (P <0.001) 3.97), which was significantly less than that of preoperative (25.35 ± 5.76) (P <0.001). A total of 8 cases of pregnancy, the cumulative pregnancy rate was 36.3% (8/22). Conclusion Ultrasound-guided transvaginal ovarian stromal laser treatment can improve the disorder of serum hormone in patients with PCOS, which is an effective method to treat ovulation disorders of PCOS.