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目的:观察和比较开腹剥除术、腹腔镜剥除术及超声引导穿刺术对子宫内膜异位囊肿伴不孕症患者卵巢功能的影响。方法:选取2011年1月-2013年6月我院收治的子宫内膜异位囊肿伴不孕症患者168例,根据患者手术治疗方案分为A、B、C三组,A组患者应用开腹剥除术,B组患者行腹腔镜剥除术,C组给予超声引导穿刺术治疗,对比三组患者手术前后促卵泡成熟激素(FSH)、黄体生成激素(LH)、雌二醇(E2)及窦卵泡数目(AFC)等卵巢储备功能指标水平的变化、临床妊娠数、流产情况及术后复发率。结果:治疗后,三组患者AFC数量均较治疗前显著下降(P<0.05),且C组AFC显著高于B、A两组(P<0.05);三组患者治疗后血清FSH、E2、FSH/LH水平均较治疗前显著提高,A组血清FSH、E2、FSH/LH水平明显高于B、C组,而C组血清FSH、E2、FSH/LH水平明显高于B组(P<0.05)。术后1、2、3年,A组妊娠率均显著低于B、C组(P<0.05),且自然流产率显著高于B、C两组(P<0.05),而B、C组妊娠率和自然流产率相比差异均无统计学意义(P>0.05)。结论:应用超声引导穿刺术及腹腔镜剥除术治疗子宫内膜异位囊肿伴不孕症患者对其卵巢储备功能影响均较小,且妊娠情况较好,临床可根据患者情况选择恰当手术方式,以提高治疗效果。
OBJECTIVE: To observe and compare the effects of laparotomy, laparoscopic ablation and ultrasound guided puncture on ovarian function in patients with endometriosis and infertility. Methods: A total of 168 patients with endometriosis and infertility admitted to our hospital from January 2011 to June 2013 were selected and divided into A, B and C groups according to the surgical treatment plan. Patients in A group were treated with open Laparotomy was performed in group B, and ultrasound-guided puncture was performed in group C. FSH, LH and E2 were compared between the three groups before and after surgery. ) And the number of antral follicles (AFC) and other indicators of ovarian reserve changes in the level of clinical pregnancy, abortion and postoperative recurrence rate. Results: After treatment, the number of AFC in three groups was significantly lower than that before treatment (P <0.05), and the AFC in group C was significantly higher than that in groups B and A (P <0.05). After treatment, the levels of serum FSH, E2, The levels of FSH, E2 and FSH / LH in group A were significantly higher than those in group B and C, while the levels of FSH, E2 and FSH / LH in group C were significantly higher than those in group B (P < 0.05). The pregnancy rates in group A were significantly lower than those in groups B and C at 1, 2 and 3 years (P <0.05), and the spontaneous abortion rates were significantly higher than those in groups B and C (P <0.05) There was no significant difference in pregnancy rate and spontaneous abortion rate (P> 0.05). Conclusion: The application of ultrasound guided laparoscopic and laparoscopic ablation of endometriosis cyst with infertility patients have little effect on their ovarian reserve, and the pregnancy is better, the clinical choice of patients according to the appropriate surgical approach , To improve the treatment effect.