Takenaka Motoki, Yano Ryuichiro, Hiraku Yuka, Shibata Mayuko, Hatano Kayoko, Yamamoto Shiori, Sato Kazuki, Yamamoto Kazushige, Morishige Ken-ichiro
Department of Obstetrics and Gynecology, Gifu University School of Medicine.
Department of Obstetrics and Gynecology, Gifu Municipal Hospital, Gifu, Japan.
J Obstet Gynaecol Res. 2015 Aug;41(8):1234-9. doi: 10.1111/jog.12701. Epub 2015 Apr 1.
The aim of this study was to compare the effects of pre-surgical medication with dienogest or leuprorelin on post-surgical ovarian function.
We conducted an exploratory study in two centers in Japan that comprised 30 patients with ovarian endometrial cysts for whom surgical excision was planned. Patients were enrolled and divided into pre-surgical medication groups with dienogest or leuprorelin for 12 weeks. Thereafter, patients were treated by laparoscopic cystectomy. The primary outcome was ovarian function post-surgery, as assessed by serum anti-Müllerian hormone (AMH) level, antral follicle count (AFC) and resumption of menses. Secondary outcome was the effect of pre-surgical medication, as assessed by the size of endometrial cysts and visual analog scale (VAS) score. Serum AMH, AFC, size of endometrial cysts, and VAS scores were measured at baseline (before medication), after medication (1 day before surgery), and at 4 and 12 weeks post-surgery.
Serum AMH levels did not change after pre-surgical medication with either dienogest or leuprorelin. Although AMH decreased after surgery, it recovered by 12 weeks post-surgery in both groups with no statistically significant difference. Mean AFC did not change after surgery in either group. Menses returned by 12 weeks post-surgery in all patients except for those who were pregnant. The rate of reduction of endometrial cyst volume did not differ between the groups. Both dienogest and leuprorelin were associated with substantial reductions in VAS scores.
There were no statistically significant differences between pre-surgical medication with dienogest and leuprorelin in post-surgical ovarian function. Both medications were effective in reducing endometrial cyst volume and VAS score.
本研究旨在比较地诺孕素或亮丙瑞林术前用药对术后卵巢功能的影响。
我们在日本的两个中心进行了一项探索性研究，纳入了30例计划行手术切除卵巢子宫内膜囊肿的患者。患者入组后被分为地诺孕素或亮丙瑞林术前用药组，用药12周。此后，患者接受腹腔镜囊肿切除术。主要结局为术后卵巢功能，通过血清抗苗勒管激素（AMH）水平、窦卵泡计数（AFC）和月经恢复情况进行评估。次要结局为术前用药的效果，通过子宫内膜囊肿大小和视觉模拟评分（VAS）进行评估。在基线（用药前）、用药后（手术前1天）、术后4周和12周测量血清AMH、AFC、子宫内膜囊肿大小和VAS评分。
地诺孕素或亮丙瑞林术前用药后血清AMH水平均未改变。虽然术后AMH下降，但两组在术后12周均恢复，且无统计学显著差异。两组术后平均AFC均未改变。除怀孕患者外，所有患者在术后12周月经恢复。两组子宫内膜囊肿体积缩小率无差异。地诺孕素和亮丙瑞林均与VAS评分大幅降低相关。
地诺孕素和亮丙瑞林术前用药在术后卵巢功能方面无统计学显著差异。两种药物均能有效减小子宫内膜囊肿体积和降低VAS评分。
