| Objective:To study the changes in ovarian reserve function and the influencing factors before and after bilateral ovarian endometriosis cyst operation combined with Gn RH-α treatment,to investigate whether serum AMH more reliable than serum reproductive hormone can predict the decline of ovarian function earlier,and to enhance the effectiveness of the therapeutic regimen and improve the living quality and pregnancy rate of patients by making reasonable evaluation on the influencing factors and hormone changes before operation,formulating operation plan and carrying out long-term management after operation.Methods:A total of 48 cases of patients with bilateral ovarian cysts,who were hospitalized in Ningbo Women and Children’s Hospital and received laparoscopic bilateral ovarian cyst cystectomy from May 2017 to February 2019,were selected and included in this research.Thereinto,27 patients had bilateral ovarian endometriosis cysts and 21 patients had bilateral ovarian benign cysts.Some of the patients were out patients and some were retrospective surgical cases.Serum AMH was collected from all the patients before operation.Patients with ovarian endometriosis cysts were injected with Gn RH-α for 6 cycles since the 5th day after operation,and their serum AMH was collected on the 2nd day and in the 1st,3rd,6th,9th and 12 th months after operation.Results:(1)The range of serum AMH in 48 patients with bilateral ovarian cysts before operation was 0.65ng/ml-8.89ng/ml(3.54±-1.20ng/ml),and negatively correlated with age,the correlation coefficient R was 0.589,the P value of correlation coefficient test was 0.007.The mean level of serum AMH was linearly and negatively correlated with age,and AMH level gradually decreased with age.(2)The mean serum AMH level in bilateral ovarian endometriosis cyst group was significantly lower than that in non-ovarian endometriosis cyst group(P<0.05).(3)The mean serum AMH level of 27 patients with bilateral ovarian endometriosis cysts was(2.91±1.49),and significantly lower than(1.54±1.04)after operation,and the difference was statistically significant(P<0.05).The mean serum AMH level before and after operation was drawn into curve charts.It can be seen from the charts that the mean serum AMH level decreased dramatically after operation,1 month after operation and 3 months after the operation combined with Gn RH-α treatment,and the mean serum AMH level began to increase gradually since 6 months after operation.(4)The patients with bilateral endometriosis cysts were divided into four groups: 20-25Y/O group,25-30 Y/O group,30-35 Y/O group and over 35 Y/O group.Analysis of variation was used to analyze the four groups.The mean serum AMH level in all the four groups before operation was statistically significant,and gradually decreased with age.The mean AMH level after operation and 1 month,3 months,6 months,9 months and 12 months after operation was not statistically significant.(5)The patients in bilateral endometriosis cyst group were divided into single locular group and multilocular group.Independent-samples T test was used to analyze the two groups.The results showed that the differences in the mean serum AMH level before and after operation and3 months,12 months after operation were not statistically significant.The difference in the mean serum AMH level 6months and 9months after operation was statistically significant(P<0.05).(6)According to the cyst diameter,patients in the endometriosis cyst group was divided into two groups: side maximum diameter ≤5cm group and side maximum diameter>5cm group.Independent-samples T test was used to analyze the two groups.The results showed that the differences in the mean serum AMH level before and after operation and 1 month and 3 months after operation were not statistically significant.The differences in the mean serum AMH level 6months,9 months and 12 months after operation were statistically significant(P<0.05).(7)According to the r-AFS score,patients in the endometriosis cyst group were divided into two groups: r-AFS ≤100 group and r-AFS score>100 group.Independent-samples T test was used to analyze the two groups.It was found that there was no statistically significant difference in the mean serum AMH level before and after operation and 1 month,3 months and9 months after operation.The difference in the mean serum AMH level 12 months after operation was statistically significant(P<0.05).(8)According to the intraoperative conditions,the bilateral ovarian endometriosis cyst group was divided into the ovarian suture hemostatic group and the ovarian electrocoagulation hemostatic group.The independent sample t test was used to analyze the preoperative and postoperative average serum AMH level of the two groups,and the difference was statistically significant(P<0.05).Moreover,the decrease rate of the average serum AMH level in the ovarian suture hemostasis group was significantly higher than that in the ovarian electrocoagulation hemostasis group,with statistically significant difference.Conclusion:(1)Ovarian endometriosis cyst can cause damage to ovarian function.(2)Age is negatively correlated with serum AMH level.Serum AMH level decreases with increasing age.Age exerts no significant impact on the recovery of postoperative ovarian reserve function.(3)Bilateral ovarian endometriosis cyst cystectomy may result in a further rapid decline of ovarian function.Different hemostatic methods during the operation may all lead to the decrease of ovarian reserve function,but the ovarian suture hemostatic operation is better than bipolar electrocoagulation for the protection of ovarian reserve function.(4)The diameter of ovarian endometriosis cysts exerts no significant impact on ovarian reserve function.The larger the diameter,the slower the recovery of postoperative ovarian function.(5)The higher the r-AFS score of bilateral ovarian endometriosis cyst,the slower the recovery of postoperative ovarian reserve function.(6)The ovarian reserve function of single ovarian bilateral endometriosis cysts recovered more quickly than multilocular ovarian bilateral endometriosis cysts in a given amount of time.(7)Bilateral ovarian endometriosis cyst operation combined with Gn RH-α treatment can further reduce ovarian reserve function,but the ovarian function starts to recover 6 months after operation. |
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