腹腔镜下不同电能对难治性多囊卵巢综合征预后的影响

目的对比腹腔镜下卵巢电灼打孔手术（LOD）时不同电能治疗难治性多囊卵巢综合征（PCOS）不孕患者的效果,探讨最佳打孔数目及卵巢负荷电能。方法对232例符合标准的PCOS患者分为4组：Ⅰ组（初始电能30 W,功率600-900 J）54例,Ⅱ组（初始电能40 W,功率800-1200 J）56例,Ⅲ组（初始电能30 W,功率〉900-1200 J）62例,Ⅳ组（初始电能40 W,功率〉1200-1600 J）60例。观察4组手术前后内分泌变化、自发性排卵率及妊娠率。结果与术前比较,4组患者的术后闭经率明显下降,排卵率则明显上升（均P〈0.01）。Ⅰ、Ⅱ、Ⅲ、Ⅳ组术后的排卵率分别为63.0%、64.3%、80.6%、63.3%,术后1a的妊娠率分别为51.9%、51.8%、70.9%、53.3%,均以Ⅲ组为高,差异有统计学意义（P〈0.05）。术后血黄体生成素（LH）、雄激素（T）、雌二醇（E2）和体重指数（BMI）水平明显降低,血卵泡生成素（FSH）则明显升高,差异均有统计学意义（P〈0.01）。结论腹腔镜下卵巢电灼打孔术电能过大时可严重影响卵巢功能,导致卵巢早衰,功率〉900-1200J,打孔7-8个时可取得较佳临床效果。

Therapeutic effect of different electrical energy on prognosis of refractory polycystic ovarian syndrome

Objective To evaluate the therapeutic effect of different electrical energy on prognosis of refractory polycystic ovarian syndrome（PCOS）.Methods 232 PCOS patients unresponsive to clomephene citrate（CC） were randomly divided into four groups.Group I had 54 cases（treated with initiated electrical energy 30W,power 600～900J）,group II had 56 cases（treated with initiated electrical energy 40W,power 800～1200J）,group III had 62 cases（treated with initiated electrical energy 30W,power 〉900～1200J）,and group IV had 60 cases（treated with initiated electrical energy 40W,power 〉1200～1600J）.The endocrine change,spontaneous ovulation and pregnant status were observed before and after the operation.Results： After operation,the amenorrhea rate significantly reduced and the ovulation rate significantly increased in the four groups.The ovulation rates in 1 year after operation were 63.0%,64.3%,80.6% and 63.3% in group I,II,III and IV,respectively.The pregnant rates in 1 year after operation were 51.9%,51.8%,70.9% and 53.3% in group I,II,III and IV,respectively,with the highest in group III.After operation,the level of LH,T,E2 and BMI decreased significantly,while FSH significantly increased.Conclusion The laparoscopic ovarian drilling treatment for PCOS is safe and effective when the power is used at 900～1200J and 7～8 holes is drilled.