Api Murat
Haseki Education and Research Hospital, Istanbul, Turkey.
Gynecol Endocrinol. 2009 Mar;25(3):159-65. doi: 10.1080/09513590802585605.
Surgical therapy with laparoscopic ovarian 'drilling' (LOD) may avoid or reduce the need for gonadotrophins or may facilitate their use. However, the procedure, though effective, can be traumatic on the ovaries, which may cause postoperative adhesions and/or diminished ovarian reserve (DOR).
To review the available literature, whether the LOD is harmful on the ovarian reserve markers.
A literature search was conducted using the keywords LOD, laparoscopic ovarian diathermy, PCOS, ovarian reserve, premature ovarian failure (POF). The MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews were searched.
All trials, case reports and letters to the editor in the PubMed database were included.
Along with the long-term clinical follow-up research articles, four that were specifically identifying the ovarian reserve tests were included in this review. Among these, three of them compared before and after LOD values, and one of them compared ovarian reserve markers among different groups of subjects; those with LOD, those with PCOS without LOD and those with normal ovulatory controls.
There were statistically significant differences between Day 3 FSH, inhibin B levels, ovarian volume and antral follicle count before and after LOD in some of the reports. Although the after LOD values were found to be lower than the before LOD values by means of ovarian reserve markers, the after values stayed higher than normal when compared with normal women without PCOS.
Although the available data in the literature is limited, there was no concrete evidence of a DOR or POF associated with LOD in women with PCOS. Most of the changes in the ovarian reserve markers observed after LOD could be interpreted as normalisation of ovarian function rather than a reduction of ovarian reserve. LOD, if applied properly, normalises the exaggerated ovarian morphologic and endocrinologic properties.
腹腔镜卵巢“打孔”（LOD）手术治疗可能避免或减少对促性腺激素的需求，或有助于其使用。然而，该手术虽有效，但可能对卵巢造成创伤，这可能导致术后粘连和/或卵巢储备功能下降（DOR）。
回顾现有文献，探讨LOD对卵巢储备标志物是否有害。
使用关键词LOD、腹腔镜卵巢透热疗法、多囊卵巢综合征（PCOS）、卵巢储备、卵巢早衰（POF）进行文献检索。检索了MEDLINE和EMBASE数据库以及Cochrane系统评价数据库。
纳入PubMed数据库中的所有试验、病例报告和致编辑的信。
除长期临床随访研究文章外，本综述还纳入了4篇专门确定卵巢储备检测的文章。其中，3篇比较了LOD前后的值，1篇比较了不同受试者组之间的卵巢储备标志物；接受LOD治疗的患者、未接受LOD治疗的PCOS患者和正常排卵对照者。
在一些报告中，LOD前后第3天的促卵泡生成素（FSH）、抑制素B水平、卵巢体积和窦卵泡计数存在统计学显著差异。尽管通过卵巢储备标志物发现LOD后的数值低于LOD前的数值，但与无PCOS的正常女性相比，LOD后的数值仍高于正常水平。
尽管文献中的现有数据有限，但尚无确凿证据表明PCOS女性中与LOD相关的卵巢储备功能下降或卵巢早衰。LOD后观察到的卵巢储备标志物的大多数变化可解释为卵巢功能正常化，而非卵巢储备减少。如果应用得当，LOD可使过度的卵巢形态和内分泌特性正常化。
