Unlu Cihat, Atabekoglu Cem S
Department of Obstetrics and Gynecology, Ankara University School of Medicine, Dikimevi-Ankara, Turkey.
Curr Opin Obstet Gynecol. 2006 Jun;18(3):286-92. doi: 10.1097/01.gco.0000193020.82814.9d.
The purpose of this review is to provide a critical summary of current knowledge on the role and effectiveness of ovarian surgery in the treatment of polycystic ovary syndrome.
Clomiphene citrate is used as a first-line treatment for ovulation induction in infertile anovulatory patients with polycystic ovary syndrome. In clomiphene citrate-resistant women, other treatment modalities such as laparoscopic electrocautery or ovulation induction with gonadotropins have been proposed as alternative therapies. Although gonadotropin treatment and laparoscopic ovarian drilling have demonstrated similar reproductive outcomes, laparoscopic ovarian drilling has some advantages over gonadotropin treatment such as lower cost per pregnancy, improvement in menstrual regularity, and better long-term reproductive performance. On the other hand, knowledge about the pathogenesis of polycystic ovary syndrome has been growing and insulin-sensitizing drugs have gained popularity as a new treatment option.
According to current data, metformin has gained popularity as first-line management in clomiphene citrate-resistant women with polycystic ovary syndrome. If ovulation does not occur within several months after treatment with metformin, after the evaluation of all pros and cons related to each treatment, laparoscopic ovarian drilling or gonadotropins may be considered as an effective option according to patient choice.
本综述旨在对卵巢手术在多囊卵巢综合征治疗中的作用及有效性的现有知识进行批判性总结。
枸橼酸氯米芬被用作多囊卵巢综合征无排卵不孕患者促排卵的一线治疗药物。对于枸橼酸氯米芬抵抗的女性，已提出其他治疗方式，如腹腔镜电灼术或用促性腺激素促排卵作为替代疗法。尽管促性腺激素治疗和腹腔镜卵巢打孔术已显示出相似的生殖结局，但腹腔镜卵巢打孔术相对于促性腺激素治疗有一些优势，如每次妊娠成本较低、月经规律性改善以及长期生殖性能更好。另一方面，关于多囊卵巢综合征发病机制的知识不断增加，胰岛素增敏药物作为一种新的治疗选择越来越受欢迎。
根据目前的数据，二甲双胍已成为枸橼酸氯米芬抵抗的多囊卵巢综合征女性一线治疗的常用药物。如果在用二甲双胍治疗数月后仍未排卵，在评估每种治疗的所有利弊后，可根据患者选择将腹腔镜卵巢打孔术或促性腺激素作为一种有效选择考虑。
