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

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