探讨腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术后，对卵巢储备功能的影响及评估卵巢储备功能的敏感指标。

选择2013年2月至2015年8月，在江苏省苏北人民医院妇科住院并行腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术治疗的115例卵巢子宫内膜异位囊肿患者为研究对象，根据手术标本组织病理学检查结果是否发现卵泡组织，将其分为A组(n＝65，有卵巢卵泡组织结构)和B组(n＝50，无卵巢卵泡组织结构)。测定2组患者术前及术后7 d、3个月及6个月血清卵泡刺激素(FSH)、雌二醇和抗苗勒管激素(AMH)水平，并采用超声监测2组患者术前及术后3个月、6个月囊肿侧卵巢窦卵泡数(AFC)及卵巢体积。采用电化学发光法测定血清FSH、雌二醇水平，采用酶联免疫吸附试验(ELISA)测定血清AMH水平。本研究遵循的程序符合江苏省苏北人民医院人体试验委员会制定的伦理学标准，得到该委员会批准，并与患者本人签署临床研究知情同意书。

①2组患者年龄≥35岁构成比、子宫内膜异位囊肿直径≥5 cm构成比、手术时间、术中出血量比较，差异均无统计学意义(P>0.05)。②术后7 d，2组患者FSH水平较术前明显上升，雌二醇和AMH水平均较术前下降，并且差异均有统计学意义(P<0.05)；术后3个月，2组患者FSH和雌二醇水平与术前比较，差异无统计学意义(P>0.05)，但AMH水平仍显著低于术前，并且差异有统计学意义(P<0.05)；术后6个月，A组患者FSH和雌二醇水平和术前比较，差异无统计学意义(P>0.05)，但AMH仍显著低于术前，并且差异有统计学意义(P<0.05)，而B组患者FSH、雌二醇和AMH水平与术前比较，差异均无统计学意义(P>0.05)。③2组患者FSH、雌二醇和AMH水平在不同时间点分别比较，差异均无统计学意义(P>0.05)。④2组术前AFC比较，差异无统计学意义(P>0.05)；术后3个月，A组AFC少于B组(P<0.05)，差异有统计学意义(P<0.05)；术后6个月比较，差异无统计学意义(P>0.05)。⑤2组囊肿侧卵巢体积在术后3个月、6个月比较，差异均无统计学意义(P>0.05)。

腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术后卵巢储备功能下降，组织病理结果显示有卵泡组织患者，其术后6个月仍处于恢复阶段。采用AMH评估卵巢储备功能可作为预测腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术后卵巢早衰的随访指标。

To explore the effect on ovarian reserve function and the sensitive marker after laparoscopic operation on unilateral ovarian endometrioma.

From February 2013 to October 2015, a total of 115 women with ovarian cyst underwent laparoscopic cystectomy were included into this study. They were divided into two groups according to histopathological analysis, group A (n=65, histopathological analysis showed ovarian follicle) and group B (n=50, histopathological analysis showed without ovarian follicle). The serum follicle-stimulating hormone (FSH), estradiol and anti-Müllerian hormone (AMH) levels before operation and at seventh day, third month and sixth month after operation were detected, meanwhile, antral follicle count (AFC) and ovarian volume before operation and at seventh day, third month and sixth month after operation were measured by ultrasonic examination. Serum FSH and estradiol levels were detected by electrochemiluminescence immunoassay, and serum AMH levels were detected by enzyme-linked immunosorbent assay (ELISA). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Northern Jiangsu People′s Hospital. Informed consent was obtained from the parents of each participating patients.

①There were no significant differences between two groups in the aspects of constitution ratio of older than 35 years old, constitution ratio of ovarian endometriotic cyst diameter≥5 cm, operation duration, bleeding volume, et al (P>0.05). ②The level of serum FSH increased at seventh day after the operation than that before the operation, and the levels of serum estradiol and AMH decreased at seventh day after the operation than that before the operation, which both had significant difference (P<0.05). The serum AMH level at third month after the operation still lower than that before operation (P<0.05), but there were no significant difference in serum FSH and estradiol (P>0.05). At the sixth month after the operation, the serum AMH of group A still significant lower than that before the operation (P<0.05), but there were no significant difference in serum FSH and estradiol compared before the operation (P>0.05). As for group B, there were no significant difference in serum FSH, estradiol and AMH levels compared before the operation(P>0.05). ③ There were no significant differences in serum FSH, estradiol and AMH levels between two groups at every different time points (P>0.05). ④ There were no significant differences between two groups in AFC before operation and at sixth month after the operation (P>0.05). The AFC in group A was less than that of group B at the third month after the operations (P<0.05). ④There were no significant difference between two groups of the sizes of ovarian volume of cyst side at the third and sixth month (P>0.05).

The ovarian reserve function is influenced after laparoscopic operation on unilateral ovarian endometrioma. The patients with ovarian follicle whose ovarian reserve function was still in the recovery phase at the sixth month after the operation. The serum AMH can be used as a more sensitive marker of ovarian reserve function assessment, it could be a follow-up marker of premature ovarian failure.