腹腔镜下不同卵巢良性囊肿剔除术对患者血清抗苗.doc

腹腔镜下囊肿剔除术对不同卵巢良性囊肿患者血清抗苗勒管激素水平的影响 谢秋娴1 洪宇2 陈婵玉1 黄韩薇1 杨纯1 （521000 广东 潮州，潮州市中心医院妇科1；510120 广州，中山大学孙逸仙纪念医院妇产科2） [摘要] 目的 通过检测手术前后卵巢良性囊肿患者血清抗苗勒管激素（AMH）水平的变化，探讨腹腔镜下囊肿剔除术对卵巢储备功能的影响。方法 回顾性分析2009年3月~2011年3月行腹腔镜下单侧良性卵巢囊肿剔除术148例患者临床资料，按病理类型分为卵巢巧克力囊肿组（巧囊组）和非巧囊组。术中均行卵巢缝合止血，未予电凝。术前、术后1个月、术后3个月、术后6个月行Kupperman评分，并抽血检测促卵泡激素（FSH）、黄体生成素（LH）、雌二醇（E2）及AMH水平，术后6个月行阴道或直肠B超测卵巢体积（Vo）、卵巢间质动脉收缩期峰值（PSV）、窦卵泡数（AFC）。 结果 手术前及手术后各随访时段两组患者Kupperman评分、FSH、LH及E2水平无明显差异（P均0.05）；术前非巧囊组AMH水平明显高于巧囊组（P0.05）, 术后1个月两组患者AMH水平均较术前明显下降，术后3个月和6个月均有所恢复，其中巧囊组下降更为明显，术后6个月AMH水平仅恢复至术前约80%左右的水平; 两组在术后6个月超声检查中，手术侧及正常侧的Vo、PSV和AFC均无明显差异（P均0.05）；术后囊肿标本病理检查提示巧囊组标本中囊壁周边可见正常卵巢组织的阳性率明显高于非巧囊组（41.67% vs. 10.61%， P0.05）。结论 腹腔镜下卵巢囊肿剔除术对卵巢囊肿患者的卵巢储备功能会产生不同程度的近期损害，与其病理类型有关，对巧囊患者的影响尤为明显，AMH是评价其影响的可选指标。 [关键词] 腹腔镜；卵巢囊肿剔除术；抗苗勒管激素；卵巢储备 Effect of laparoscopic cystectomy on serum anti-mullerian hormone level in patients with diverse benign ovarian cysts XIE Qiu-xian1, HONG Yu2, CHEN Chan-yu1, Huang Han-wei1, Yang Chun1 （1Department of Gynecology，The Central Hospital, Chao-zhou 521000，Guangdong，China; 2Department of Obstetrics and Gynecology，Memorial Hospital of Sun Yat-sen University，Guangzhou 510120，Guangdong，China) [Abstract] Objective To evaluate the effect of laparoscopic cystectomy on ovarian reserve in patients with diverse benign ovarian cysts by investigating the serum anti-mullerian hormone (AMH) level before and after operation. Methods A total of 148 patients who underwent laparoscopic cystectomy due to unilateral ovarian cyst were recruited in this retrospective analysis. Endometrioma group included 72 patients with ovarian endometrioma. Other 66 patients with benign ovarian cyst other than endometrioma were included in Non-endometrioma group. Kupperman index was recorded, and serum FSH, LH, E2 and AMH levels were measured before operation and at 1-month, 3-month and 6-month follow-up visit afterwards. Ovarian volume (Vo), the peak systolic velocity (PSV) and antral follicle counts (AFC) were determined at 6-month postopera