Clinical evaluation of ovarian reserve function after laparoscopic cystectomy on unilateral ovarian endometriotic cyst

doi:10.3877/cma.j.issn.1673-5250.2017.01.017

Objective

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

Methods

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.

Results

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).

Conclusions

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.

Key words: Ovarian endometriotic cyst, Laparoscopes, Pathology, Sex hormone, Anti-Mullerian hormone, Women

图1 光学显微镜下子宫内膜异位囊肿囊壁的病理组织观察结果(HE染色，低倍镜)

表1 2组卵巢子宫内膜异位囊肿患者一般临床资料比较

组别	例数	年龄≥35岁[例数(%)]	子宫内膜异位囊肿直径≥5 cm[例数(%)]	手术时间(min, ±s)	术中出血量(mL, ±s)
A组	65	42(64.6)	51(78.5)	40.2±10.5	28.3±11.3
B组	50	35(70.0)	33(66.0)	38.1±9.2	25.6±9.7
检验值	?	χ²＝0.14	χ²＝1.78	t＝0.98	t＝1.12
P值	?	0.71	0.18	0.33	0.27

表1 2组卵巢子宫内膜异位囊肿患者一般临床资料比较

组别	例数	年龄≥35岁[例数(%)]	子宫内膜异位囊肿直径≥5 cm[例数(%)]	手术时间(min, ±s)	术中出血量(mL, ±s)
A组	65	42(64.6)	51(78.5)	40.2±10.5	28.3±11.3
B组	50	35(70.0)	33(66.0)	38.1±9.2	25.6±9.7
检验值	?	χ²＝0.14	χ²＝1.78	t＝0.98	t＝1.12
P值	?	0.71	0.18	0.33	0.27

表2 2组卵巢子宫内膜异位囊肿患者术前及术后不同时间点卵泡刺激素、雌二醇及抗苗勒管激素水平比较(±s)

组别	例数	FSH (mIU/mL)				雌二醇(pg/mL)
组别	例数	术前	术后7 d	术后3个月	术后6个月	术前	术后7 d	术后3个月	术后6个月
A组	65	6.3±2.9	9.0±2.3	6.5±2.1	6.3±1.9	66.2±11.3	53.2±16.5	63.8±12.3	62.3±13.3
B组	50	6.5±1.3	8.8±0.9	6.8±0.9	6.4±2.0	62.2±6.4	51.1±6.3	59.7±9.3	60.7±10.2
t值	?	1.96	1.67	1.73	0.97	1.53	1.89	1.56	0.96
P值	?	0.27	0.32	0.23	1.00	0.17	0.13	0.11	1.01
组别	例数	AMH(ng/mL)
组别	例数	术前	术后7 d	术后3个月	术后6个月
A组	65	3.3±1.3	1.9±0.7	2.0±0.9	2.3±0.9
B组	50	3.2±1.0	1.9±0.9	2.3±0.9	3.1±1.0
t值	?	0.67	0.83	1.87	2.32
P值	?	1.21	1.38	0.14	0.02

表2 2组卵巢子宫内膜异位囊肿患者术前及术后不同时间点卵泡刺激素、雌二醇及抗苗勒管激素水平比较(±s)

组别	例数	FSH (mIU/mL)				雌二醇(pg/mL)
组别	例数	术前	术后7 d	术后3个月	术后6个月	术前	术后7 d	术后3个月	术后6个月
A组	65	6.3±2.9	9.0±2.3	6.5±2.1	6.3±1.9	66.2±11.3	53.2±16.5	63.8±12.3	62.3±13.3
B组	50	6.5±1.3	8.8±0.9	6.8±0.9	6.4±2.0	62.2±6.4	51.1±6.3	59.7±9.3	60.7±10.2
t值	?	1.96	1.67	1.73	0.97	1.53	1.89	1.56	0.96
P值	?	0.27	0.32	0.23	1.00	0.17	0.13	0.11	1.01
组别	例数	AMH(ng/mL)
组别	例数	术前	术后7 d	术后3个月	术后6个月
A组	65	3.3±1.3	1.9±0.7	2.0±0.9	2.3±0.9
B组	50	3.2±1.0	1.9±0.9	2.3±0.9	3.1±1.0
t值	?	0.67	0.83	1.87	2.32
P值	?	1.21	1.38	0.14	0.02

表3 2组卵巢子宫内膜异位囊肿患者窦卵泡数及囊肿侧卵巢体积比较(±s)

组别	例数	AFC(个)
组别	例数	术前	术后3个月	术后6个月
A组	65	8.0±1.3	5.9±1.4	9.0±2.8
B组	50	8.2±2.0	7.8±0.6	8.9±3.1
t值	?	0.96	2.66	1.23
P值	?	1.22	0.03	0.72
组别	例数	囊肿侧卵巢体积(cm³)
组别	例数	术后3个月	术后6个月
A组	65	6.3±0.9	6.4±1.1
B组	50	6.5±1.3	6.6±0.9
t值	?	1.22	0.92
P值	?	0.66	1.31

表3 2组卵巢子宫内膜异位囊肿患者窦卵泡数及囊肿侧卵巢体积比较(±s)

组别	例数	AFC(个)
组别	例数	术前	术后3个月	术后6个月
A组	65	8.0±1.3	5.9±1.4	9.0±2.8
B组	50	8.2±2.0	7.8±0.6	8.9±3.1
t值	?	0.96	2.66	1.23
P值	?	1.22	0.03	0.72
组别	例数	囊肿侧卵巢体积(cm³)
组别	例数	术后3个月	术后6个月
A组	65	6.3±0.9	6.4±1.1
B组	50	6.5±1.3	6.6±0.9
t值	?	1.22	0.92
P值	?	0.66	1.31

[1]	李长华，华馥，高迎春，等．腹腔镜手术治疗卵巢子宫内膜异位囊肿126例临床分析[J/CD]．中华妇幼临床医学杂志(电子版), 2010, 6(1)：36-38.
[2]	张有新，吴君梅. 腹腔镜用于卵巢子宫内膜异位囊肿治疗的疗效观察[J]．中外医疗，2014, 18(15): 85-86.
[3]	朱湘红，葛春晓，汤晓秋，等．电凝在腹腔镜卵巢囊肿手术中对卵巢储备功能的影响[J]．中国微创外科杂志，2011，11(1)：42-46.
[4]	Benaglia L, Somigliana E, Vighi V, et al. Rate of severe ovarian damage following surgery for endometriomas[J]. Hum Reprod, 2010, 25(3): 678-682.
[5]	谢幸，苟文丽，林仲秋，等. 妇产科学.8版[M]. 北京：人民卫生出版社,2013：270.
[6]	赵文荣，杨丹．卵巢内膜样囊肿与恶变相关分析[J]. 复旦学报(医学版)，2009，36(6)：760-763.
[7]	江楠，岳倩，段玉英，等．垂体后叶素水分离法在腹腔镜下卵巢子宫内膜异位囊肿剥除术中的应用及对卵巢功能的影响[J]. 现代妇产科进展,2013, 22(7): 581-583.
[8]	刘建华．卵巢子宫内膜异位囊肿手术和卵巢功能保护[J]．中国实用妇科与产科杂志，2009, 25(9): 668-671.
[9]	张英兰，马彩虹，王华，等．子宫内膜异位囊肿剔除术后标本的病理分析[J]．中国妇幼保健，2013, 28(5): 769-771.
[10]	Clement PB. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects[J]. Adv Anat Pathol，2007, 14(4): 241-260.
[11]	杨冰，叶元，秦辛玲，等．血清抗苗勒管激素在预测围绝经期女性卵巢功能中的应用[J]．山东医药，2013, 53(16): 14-17.
[12]	杨兰，王爱华，范倩倩，等．卵巢储备功能下降女性的生命质量及危险因素分析[J]．中国循证医学杂志，2013, 13(11): 1294-1297.
[13]	范玉婷,梁晓燕. 卵巢储备及其检测方法评价[J]. 实用妇产科杂志,2015, 31(1)：1-4.
[14]	程遵华,项晓宇,董莉，等. 经阴道彩色多普勒超声对排卵期卵巢动脉血流动力学研究[J]．临床超声医学杂志,2011，13(11)：729-731.
[15]	胡琳莉，孙莹璞. 卵巢储备功能与卵巢反应性评估[J]. 中国实用妇科与产科杂志，2015，31(1)：18-21.
[16]	Dewailly D, Anderson CY, Balen A, et al. The physiology and clinical utility of anti-Mullerian hormone in women[J]. Hum Reprod Update, 2014, 20(3): 370-385.
[17]	da Silva AL, Even M, Grynberg M, et al. Anti-Müllerian hormone: player and marker of folliculogenesis[J]. Gynecol Obstet Fertil, 2010, 38(7-8): 471-474.
[18]	Peigne M, Decanter C. Serum AMH level as a marker of acute and long-term effects of chemotherapy on the ovarian follicular content: a systematic review[J]. Reprod Biol Endocrinol, 2014, 12(1): 1-10.
[19]	Alborzi S, Keramati P, Younesi M, et al. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas[J]. Fertil Steril, 2014, 101(2): 427-434.
[20]	史精华，冷金花，宋楠，等．腹腔镜卵巢子宫内膜异位囊肿剥除术对卵巢储备功能的影响[J]．现代妇产科进展，2010, 19(7): 113-115.
[21]	冷金花，戴毅．合理利用能力器械，提高手术效果及安全性[J]. 中国实用妇科与产科杂志，2016，32(7): 601-603.

[1]	Ziyu Li, Xinxing Lu, Shuangxi Li, Fei Shan. The selection of reconstruction methods in laparoscopic surgery for adenocarcinoma of esophagogastric junction[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 5-8.
[2]	Leping Li, Ronghua Zhang, Liang Shang. Laparoscopic lymph node dissection for adenocarcinoma of esophagogastric junction[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 9-12.
[3]	Fangpeng Chen, Dawei Yang, Congwen Jin. Effect of laparoscopic proximal gastrectomy combined with modified esophagogastrostomy to reconstruct His Angle in patients with postoperative reflux esophagitis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 15-18.
[4]	Jie Xu, Yajun Li, Junwei Han. Comparison of the efficacy of radical laparoscopic total gastrectomy in the treatment of overweight gastric cancer with two approaches[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 19-22.
[5]	Jia Ren, Shenghui Ma, Xin Wang, Xiuxia Shi, Shuyun Cai. Clinical observation of laparoscopic total gastrectomy and interposition jejunal gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 31-34.
[6]	Lixia Zhao, Chunxia Wang, Yifeng Chen, Dongping Hu, Weisheng Zhang, Tao Wang, Honglai Zhang. Effects of visceral obesity on early complications after laparoscopic radical resection for rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 35-39.
[7]	Ji Han, Li Yang, Yu Chen. Study on the relationship between abdominal morphological CT parameters and blood loss during total laparoscopic gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 88-91.
[8]	Lu Wang, Lijun Zhou. Effects of different anastomotic methods in total laparoscopic distal subtotal gastrectomy on gastric function recovery and complication rate in patients with gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 92-95.
[9]	Wang Feng, Zhenzhong Ma, Linhua Tang. Clinical study of CT scanning 3D reconstruction in laparoscopic hepatectomy for intrahepatic cholangiocarcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 104-107.
[10]	Su Yan, Bowen Huo. Laparoscopic radical dissection for adenocarcinoma of esophagogastric junction[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 13-13.
[11]	Chaojun Zhang, Xinpu Yuan. Laparoscopic assisted radical resection of low rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 602-602.
[12]	Minhua Zheng, Tianyu Jiang, Xuan Zhao, Junjun Ma. 30 years historical development and future outlook of laparoscopic surgery for rectal cancer in China[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 591-595.
[13]	Haiwang Liu, Hai Shi, Lifeng Shang. Comparison of different staplers in Roux-en-Y anastomosis during laparoscopic radical gastrectomy for distal gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 643-646.
[14]	Jie Xu, Yajun Li, Yiwen Feng. Comparison of recent follow-up between laparoscopic D2 radical surgery and conventional radical surgery for advanced gastric cancer after SOX neoadjuvant chemotherapy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 647-650.
[15]	Quanyou Lai, Yuan Gao, Jianlin Wang, Shibin Qu, Dan Wei, Wei Peng. Effects of 3D reconstruction technology combined with laparoscopic precision hepatectomy on the levels of CD4+, CD8+ and immunoglobulin in patients with liver cancer after surgery[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 651-654.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export