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目的探讨腹腔镜手术联合戈舍瑞林对卵巢巧克力囊肿合并不孕症患者雌孕激素水平、临床表现及妊娠的影响。方法将86例卵巢巧克力囊肿合并不孕患者随机分为A、B两组,每组43例。A组采用腹腔镜手术联合戈舍瑞林联合方案治疗,B组单纯采用腹腔镜手术方案治疗。比较两组治疗前黄体生成素(LH)、卵泡雌激素(FSH)、血清雌二醇(E2)水平,性交疼痛、盆腔疼痛、痛经的疼痛情况,术后1年内妊娠情况及复发率。结果治疗后两组患者3种激素水平均较治疗前下降(P<0.05)。治疗后A组患者血清E2水平显著低于B组,两组比较,差异有统计学意义(P<0.05)。治疗后两组性交痛、盆腔痛、痛经VAS评分均显著下降,且A组均低于B组,两组比较,差异均有统计学意义(P<0.05)。治疗后A组患者Ⅲ~Ⅳ期患者妊娠率高于对照组两组比较,差异有统计学意义(P<0.05)。术后对所有患者进行为期1年随访,A组复发2例(4.65%),B组复发9例(20.93%),两组比较,差异有统计学意义(χ~2=5.126,P=0.024)。结论腹腔镜联合戈舍瑞林联合治疗方案能够有效治疗卵巢巧克力囊肿合并不孕患者,Ⅲ~Ⅳ期患者术后妊娠率高且安全性高。
Objective To investigate the effect of laparoscopic surgery combined with goserelin on the levels of estrogen, progesterone and progesterone in patients with ovarian chocolate cyst complicated with infertility, clinical manifestations and pregnancy. Methods 86 cases of ovarian chocolate cyst with infertility were randomly divided into A and B groups, 43 cases in each group. Group A was treated with laparoscopic surgery combined with goserelin, and group B with laparoscopic surgery alone. The levels of LH, FSH, E2, pain of intercourse, pelvic pain and dysmenorrhea were compared between the two groups before treatment and the pregnancy rate and relapse rate within 1 year after operation. Results After treatment, the levels of three hormones in both groups were significantly lower than those before treatment (P <0.05). After treatment, the level of serum E2 in group A was significantly lower than that in group B, the difference was statistically significant (P <0.05). After treatment, the VAS scores of painful intercourse, pelvic pain and dysmenorrhea were significantly decreased in both groups, and the scores of VAS in both groups were significantly lower than those in group B, the difference was statistically significant (P <0.05). After treatment, the pregnancy rate in patients with stage Ⅲ ~ Ⅳ in group A was higher than that in control group, the difference was statistically significant (P <0.05). All the patients were followed up for 1 year after operation. The recurrence rate in group A was 2 cases (4.65%) in group A and 9 cases (20.93%) in group B. The difference was statistically significant (χ ~ 2 = 5.126, P = 0.024 ). Conclusion Laparoscopic combined with goserelin can effectively treat patients with ovarian chocolate cyst complicated with infertility. Patients with stage Ⅲ ~ Ⅳ have high pregnancy rate and high safety.