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目的探讨腹腔镜卵巢打孔术治疗耐克罗米分多囊卵巢综合征(PCOS)合并不孕的临床价值、适应证及机理。方法对符合PCOS标准的不孕症37例采用腹腔镜电针双侧卵巢打孔术,观测术后排卵、妊娠、流产情况,比较手术前后血FSH,LH,LH/FSH,T,PRL,E2值的变化及月经情况的改变。结果术后血清LH、LH/FSH、T及PRL水平较术前明显下降;而FSH和E2术后较术前轻度降低。术后排卵率为89·19%。妊娠率为54·05%,早期流产率为10·00%,无一例发生卵巢过度刺激综合征(OHSS)。结论腹腔镜卵巢打孔术可提高PCOS合并不孕患者的自然排卵率及对克罗米芬(CC)的敏感性,从而提高妊娠率,是PCOS不孕症特别是难治性PCOS患者恢复卵巢生理功能的有效手段,但应掌握手术时机和手术指征。术后3个月未妊娠者尽早采用促排卵药物以提高妊娠率。
Objective To investigate the clinical value, indications and mechanism of laparoscopic ovarian drilling in the treatment of patients with polycystic ovary syndrome (PCOS) with noctuid. Methods 37 cases of infertility who met PCOS standard were treated with laparoscopic electro-acupuncture bilateral ovarian drilling. The ovulation, pregnancy and abortion were observed before and after operation. Blood FSH, LH, LH / FSH, T, PRL, E2 Changes in values and changes in menstrual conditions. Results The postoperative serum levels of LH, LH / FSH, T and PRL were significantly decreased compared with that before operation, while FSH and E2 were slightly lower than those before operation. Ovulation rate after surgery was 89.19%. The pregnancy rate was 54.05%, the rate of early miscarriage was 10.00%, and none of them had ovarian hyperstimulation syndrome (OHSS). Conclusion Laparoscopic ovarian drilling can improve the natural ovulation rate and the sensitivity to clomiphene citrate in patients with PCOS complicated with infertility so as to improve the pregnancy rate and restore ovarian physiological function in patients with PCOS infertility, especially refractory PCOS Effective means, but should grasp the timing of surgery and surgical indications. 3 months after pregnancy as early as possible to use ovulation induction drugs to improve pregnancy rate.