Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Hangzhou, China.
Medicine (Baltimore). 2021 Feb 19;100(7):e24362. doi: 10.1097/MD.0000000000024362.
This study investigates the effect of 2 laparoscopic methods on ovarian reserve in patients of reproductive age with endometriomas.This was a retrospective study performed at a tertiary medical center from Jan 1st to Dec 31st, 2016. Laparoscopic cystectomy (group 1, 46 patients) and laparoscopic ovarian drainage and ablation with bipolar coagulation at low power (group 2, 30 patients) were performed to treat endometriomas larger than 3 cm. Anti-Müllerian hormone was used to assess ovarian reserve before and after surgery.There were no statistically significant differences in patients' baseline clinical characteristics, endometriotic stage, operative time, and follow-up time between the groups. The mean serum anti-Müllerian hormone concentration decreased significantly from 4.25 ng/ml to 3.40 ng/ml in group 1 compared with 4.47 ng/ml to 3.95 ng/ml in group 2 (P = .04). Pregnancy rates were 71.05% in group 1 and 73.08% in group 2, with a mean follow-up of 30.40 months and 32.35 months (P > .99), respectively. Although there was no statistical significance, the recurrence rate in group 1 was lower than that in group 2 (4.35% vs 16.67%, respectively; P = .11). The mean diameter of recurrent cysts was 1.75 cm in group 1 and 1.54 cm in group 2 (P = .13).Appropriate laparoscopic electrocautery of the endometrioma wall with a bipolar instrument may be a valid alternative to traditional laparoscopic cystectomy, with less effects on ovarian reserve.
本研究旨在探讨两种腹腔镜方法对有生育需求的子宫内膜异位症患者卵巢储备功能的影响。这是一项回顾性研究，于 2016 年 1 月 1 日至 12 月 31 日在一家三级医疗中心进行。对大于 3cm 的子宫内膜异位症囊肿采用腹腔镜囊肿切除术（第 1 组，46 例）和低功率双极电凝腹腔镜卵巢引流及消融术（第 2 组，30 例）进行治疗。采用抗苗勒管激素（AMH）评估手术前后的卵巢储备功能。两组患者的基线临床特征、内异症分期、手术时间和随访时间无统计学差异。与第 2 组相比，第 1 组患者的血清 AMH 浓度从 4.25ng/ml 显著下降至 3.40ng/ml（P=0.04）。第 1 组的妊娠率为 71.05%，第 2 组为 73.08%，平均随访时间分别为 30.40 个月和 32.35 个月（P＞0.99）。虽然无统计学意义，但第 1 组的复发率低于第 2 组（分别为 4.35%和 16.67%；P=0.11）。第 1 组的复发囊肿平均直径为 1.75cm，第 2 组为 1.54cm（P=0.13）。使用双极器械对子宫内膜异位症囊肿壁进行适当的腹腔镜电灼可能是一种替代传统腹腔镜囊肿切除术的有效方法，对卵巢储备功能的影响较小。
