本文關(guān)鍵詞： 卵巢子宮內(nèi)膜異位囊腫 不孕癥 腹腔鏡 囊腫壁電灼術(shù) 卵巢儲備功能　出處：《浙江大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 探討卵巢子宮內(nèi)膜異位囊腫(以下簡稱內(nèi)異囊腫)合并不孕患者行腹腔鏡下內(nèi)異囊腫切開放液術(shù)、腹腔鏡下內(nèi)異囊腫切開放液+囊壁電灼術(shù)和腹腔鏡下內(nèi)異囊腫剝除術(shù)三種術(shù)式對卵巢儲備功能的影響。 方法： 回顧性收集2011年5月-2013年9月83例患者,所有患者術(shù)前均有內(nèi)異囊腫合并不孕病史,根據(jù)不同術(shù)式分成3組。A組32例,行腹腔鏡下內(nèi)異囊腫切開放液術(shù)；B組25例,行腹腔鏡下內(nèi)異囊腫切開放液+囊壁電灼術(shù)；C組26例,行腹腔鏡下內(nèi)異囊腫剝除術(shù)。分別測定3組患者術(shù)前、術(shù)后第1次月經(jīng)和第3次月經(jīng)第2-3天的基礎(chǔ)卵泡刺激素(bFSH)、雌二醇(bE2)水平及術(shù)前術(shù)后分別經(jīng)陰道B超測術(shù)側(cè)卵巢和健側(cè)卵巢的竇狀卵泡數(shù)以及總竇卵泡數(shù),以比較卵巢儲備功能。 結(jié)果： A組：術(shù)后第一次bFSH、bE2與術(shù)前相比有明顯改善,差異有顯著性(P0.05)；B組：術(shù)后第一次bFSH與術(shù)前bFSH相比有明顯改善,差異有顯著性(P0.05),術(shù)后總竇卵泡數(shù)與術(shù)前總竇卵泡數(shù)相比有明顯增加,差異也有顯著性(P0.05)；C組：術(shù)后第一次bFSH與術(shù)前bFSH相比無顯著性差異。三組術(shù)前bFSH、bE2無顯著性差異,A組與B組術(shù)前術(shù)側(cè)竇卵泡數(shù)、總竇卵泡數(shù)無顯著性差異,但與C組相比均有顯著性差異(P0.05),C組術(shù)前術(shù)側(cè)竇卵泡數(shù)和總竇卵泡數(shù)明顯多于A組與B組。A組、B組術(shù)前bFSH與術(shù)后第一次bFSH差值與C組相比有顯著性差異(P0.05),A組、B組術(shù)后第一次bFSH改善較C組明顯。A組、B組術(shù)側(cè)竇卵泡數(shù)手術(shù)前后差值與C組相比也有顯著性差異(P0.05),A組、B組術(shù)側(cè)竇卵泡數(shù)術(shù)后增加數(shù)目明顯多于C組。B組手術(shù)前后總竇卵泡數(shù)差值與A組、C組相比有顯著性差異(P0.05),B組總竇卵泡數(shù)術(shù)后增加明顯多于A組、C組(P0.05)。 結(jié)論： 子宮內(nèi)膜異位癥合并不孕癥患者特別是術(shù)前合并卵巢儲備功能下降患者行腹腔鏡內(nèi)異囊腫切開放液術(shù)或切開放液+囊壁電灼術(shù)與傳統(tǒng)腹腔鏡下內(nèi)異囊腫剝除術(shù)相比,前兩種術(shù)式更有利于保護(hù)卵巢儲備功能,術(shù)后第一次bFSH有明顯下降,并可增加竇卵泡數(shù),有助于改善卵巢儲備功能,可能有助于提高生育力。切開放液術(shù)與切開放液+囊壁電灼術(shù)相比,后者更有利于增加總竇卵泡數(shù),可能更有利于提高獲卵率,是可以優(yōu)選的手術(shù)方式。
[Abstract]:Objective:. To investigate the laparoscopic incision and exudation of endometriosis cyst (endometriosis cyst) combined with infertility in patients with ovarian endometriosis. Effects of laparoscopic excision and excision of internal cyst on ovarian reserve function. Methods:. From May 2011 to September 2013, 83 patients were retrospectively collected. All the patients had history of infertility before operation. According to different operation methods, 32 cases were divided into three groups: group A (n = 32) and group B (n = 25). Group C (n = 26) underwent laparoscopic excision and exfoliation of endocyst (n = 26). The levels of basal follicle stimulating hormone (bFSH), estradiol (E _ 2) and the number of antral follicles and the number of common antral follicles in the ovaries and normal ovaries were measured before and after the first menstruation and 2-3 days after the third menstruation, respectively, to compare the reserve function of the ovaries. Results:. Group A: the first postoperative bFSHN bE2 was significantly improved compared with that before operation, and the difference was significant (P 0.05): the first postoperative bFSH was significantly improved compared with the preoperative bFSH, the difference was significant (P0.05), and the number of total antral follicles was significantly increased compared with the preoperative total antral follicles. There was no significant difference in the number of antral follicles and the total number of antral follicles between group A and group B before operation, and there was no significant difference between group A and group B in the number of lateral antral follicles and the number of total antral follicles in the first time after operation compared with bFSH before operation, but there was no significant difference in the number of follicles between group A and group B before operation. However, there were significant differences in the number of antral follicles and total antral follicles between group C and group C before operation than between group A and group B (P 0.05) and the difference of the first bFSH between group A and group B (P 0.05) and the difference between group B (P 0.05) and group B (P 0.05). The difference in the number of antral follicles before and after operation in group A was significantly higher than that in group C (P 0.05). The number of antral follicles in group B was significantly higher than that in group C (P 0.05). The number of antral follicles in group B was significantly higher than that in group C before and after operation. There was significant difference in the number of follicles between group A and group C. The number of total antral follicles in group B was significantly higher than that in group A (P 0.05). Conclusion:. The patients with endometriosis complicated with infertility, especially the patients with ovarian reserve dysfunction before operation, were treated with laparoscopic endocyst incision and fluid exfoliation or incision of cystic wall cauterization, compared with the traditional laparoscopic excision of endometriosis. The first two methods were more helpful to protect ovarian reserve function, bFSH decreased significantly at the first time after operation, and increased the number of antral follicles, which was helpful to improve ovarian reserve function. Compared with electrocautery, the latter is more favorable to increase the number of follicles in the common antrum, and may be more favorable to increase the rate of oocyte acquisition, which is the best method of operation.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.71

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