卵巢手术在多囊卵巢综合征中的作用。

The role of ovarian surgery in polycystic ovary syndrome.

作者信息

Farquhar Cynthia M

机构信息

University of Auckland, National Women's Hospital, Auckland, New Zealand.

出版信息

Best Pract Res Clin Obstet Gynaecol. 2004 Oct;18(5):789-802. doi: 10.1016/j.bpobgyn.2004.06.002.

DOI:10.1016/j.bpobgyn.2004.06.002

PMID:15380147

Abstract

Problems in inducing ovulation in women with polycystic ovary syndrome (PCOS) and anovulation are well recognized. In 1935, Stein and Leventhal first described surgical treatment by ovarian wedge resection at laparotomy for women with anovulation and PCOS. Ovarian wedge resection was eventually abandoned because of the significant risk of postsurgical adhesion formation, which resulted in tubal adhesions, and because of the advent of medical ovulation induction with clomiphene and gonadotrophins. However, since the arrival of minimally invasive surgical techniques, laparoscopic ovarian surgery has become feasible. The potential advantages of laparoscopic ovarian surgery include repeated single ovulations and less adhesion formation. Lowered costs make ovarian surgery an attractive alternative to gonadotrophins. However, although many case series have suggested that ovarian surgery is an effective strategy, few randomized, controlled trials have been undertaken comparing the success rates of surgery with gonadotrophins. The long-term concerns with surgery include adhesion formation and premature ovarian failure.

摘要

多囊卵巢综合征（PCOS）女性诱导排卵及无排卵问题已广为人知。1935年，斯坦因（Stein）和莱文索尔（Leventhal）首次描述了通过剖腹手术行卵巢楔形切除术治疗无排卵和PCOS女性。卵巢楔形切除术最终被放弃，原因是术后粘连形成风险高，会导致输卵管粘连，以及出现了用克罗米芬和促性腺激素进行药物诱导排卵的方法。然而，自微创外科技术出现以来，腹腔镜卵巢手术已变得可行。腹腔镜卵巢手术的潜在优势包括反复单次排卵和较少的粘连形成。成本降低使卵巢手术成为促性腺激素的有吸引力的替代方案。然而，尽管许多病例系列表明卵巢手术是一种有效的策略，但很少有随机对照试验比较手术与促性腺激素的成功率。手术的长期问题包括粘连形成和卵巢早衰。