Clinical Observation Of Polycystic Ovary Syndrome Between Laparoscopic Surgery And Medical Treatment

Objective: To investigate the continuing anovulatory polycystic ovary syndrome (PCOS) patients with the efficacy of the use of ovulation induction and long-term prognosis.Methods: clomiphene (CC) resistance of 52 cases of patients with polycystic ovary syndrome. A total of 238 treatment cycles, were randomly divided into two groups (1) laparoscopic surgery group perforated electroco- agulation; (2) dayin -35 + metformin group. Before and after treatment to observe the FSH, LH, T, E2, PRL, LH / FSH and bilateral ovarian volume, follicle number and follicle diameter change; determined based on basal body temperature (BBT) and B-monitoring ovulation; and follow-up pregnancy situation.Data and Methods:Object: Study collected from March 2007 to September 2008 in the Second Hospital of Jilin University in out-patient clinics and hospitalized patients clomiphene (CC) resistance of 52 cases of patients with polycystic ovary syndrome, diagnosed in 2003 by the European Society of Human Reproduction and Embryology and American Society for Reproductive Medicine recommen- dation of the Expert Meeting on the Rotterdam criteria:①thinning hair ovulation or anovulation;②hormone Kaohsiung clinical performance and / or hyperandrogenism;③ultrasound showed polycystic ovary. 3 in line with the above-mentioned two, and the exclusion of other diseases such as hormone Kaohsiung congenital adrenal hyperplasia, Cushing syndrome, androgen secreting tumors. Hysterosalpingography, the man had a normal routine examination of semen. Without intrauterine lesions and ovarian cysts. Serum prolactin, thyroxine, thyroid-stimulating hormone level of normal, non-systemic diseases in recent months without an ovulation treatment, within 3 months of blood, urine, blood alcohol alanyl aminotransferase (ACT), blood urea nitrogen (BUN ), creatinine (Cr), glucose normal. By clomiphene-norms (CC) ovulation induction treatment failure(Clomiphene-50 ~ 100 mg, one day, the menstrual cycle to start the first five days, once a five days for a course of treatment, total of three treatments. B super ovulation monitoring, more than the completion of treatment by the patient). The average age (30.0±3.5) years of age, infertility period (5.5±3.2) years. A total of 117 treatment cycles, were randomly divided into 2 groups:(1) electro-coagulation laparoscopic ovarian drilling operation group; (2) of dayin-35 + metformin group of the British. Before and after treatment to observe the FSH, LH, T, E2, PRL, LH / FSH and bilateral ovarian volume, follicle number and follicle diameter change; determined based on basal body temperature (BBT) and B-monitoring ovulation; and follow-up pregnancy situation.Methods: electrocoagulation laparoscopic ovarian drilling group (A) preoperative preparation with laparotomy. The use of general anesthesia, the patient supine check. Umbilical incision in the skin, a long 11mm, pneumoperi- toneum needle, to build CO2 pneumoperitoneum, umbilical placed 10mm Trocar, laparoscopic placement. Home in the lower abdomen on both sides of 5mm Trocar, holes for the operation. To head lower in patients with hip high, arranged intestine, pelvic organs exposed, check the uterus, fallopian tubes and ovaries situation. By intrauterine injection of methylene blue liquid tube to check whether the bilateral tubal patency. According to Song Yanfeng introduced〔1〕, etc. will be divided into two types of ovary: cyst and sclerosis. But often at the same time the existence of two situations, with the main one. 25 cases of this group in 18 cases of vesicular-type-based, mainly in seven cases of sclerosis. Of which 23 cases of ovarian increases, only two cases of ovarian near normal. PCOS diagnosed after ovarian fixed, far away from the door with ovarian unipolar electrocoagulation vesicles in the egg surface perforated convex Department electrocoagulation to avoid electrocautery ovarian doors, to ensure that ovarian blood supply. On each side of the fight in the ovary 4 to 6 holes, power 30 ~ 40W, hole depth of about 2 ~ 4 mm, a diameter of about 2 ~ 4 mm, see there is light yellow follicular fluid outflow to reduce ovarian volume. As far as possible to shorten the coagulation time, patients with cold saline flush ovary, ovarian avoid thermal damage, and get sent a little ovarian tissue biopsy. More than those of the bleeding to the drums or electric condensate weiqiao to 3-0 suture line bleeding [2, 3], the combined pelvic adhesions distal tubal obstruction, and at the same time break down adhesions and fallopian tube ostomy surgery done before the end of Liquid blue are open tubal patency test. Saline flush pelvic surgery and ovarian surface applied anti-stick adhesive 5ml suspension Ning. All the patients after three days of antibiotics to prevent infection, 6h to allow patients to get out of bed after the activities took place in order to prevent adhesion.dayin -35 + metformin group (B group) or to withdraw from the menstrual cycle of bleeding the first 5 days of the British service dayin-35 (containing cyproterone acetate 2 mg + ethinyl estradiol 0.035 mg, the German company Schering) 1 tablets, one times / d, continuous twenty-one days. At the same time, oral metformin 500 mg, tid, for 8 to 12 weeks; such as a distinct gastrointestinal medication responders can be 250 mg, 3 times / d, seven days no particular discomfort, read 500 mg, 3 times / d. dayin-35 Of the British to take three cycles, the review of the basis of sex, the number of follicles sinus, as well as hormone based on the observed clinical symptoms of Kaohsiung to improve the situation to decide whether to continue the original treatment cycle 3. Withdrawal bleeding after stopping the first 2 ~ 5 d and 5 review vaginal sex color line follicle count sinus.Results:1. LH, T concentration is higher, after a larger decrease in both, and a higher ovulation rate, easy to conceive.2. Two groups of treatment the average serum hormone returned to normal between the two groups no significant difference; the two groups after treatment than before treatment were significantly different (P <0.05).3. Of two groups laparoscopic electrocoagulation treatment cycle, the shortest hole, the highest pregnancy rate, the rate of multiple births, the lowest abortion rate.Conclusion:1.Low-dose FSH alleviate high drug prices by the program, oral dayin -35, inhibited androgen target organ for all the appropriate role, the study found that patients with the oral part of the United dayin-35 9 ~ 12 months after the cycle has not yet serum levels of reproductive hormones reached the normal level, and after stopping a short time after the CC-resistant patients with ovarian sensitivity to return to pre-medication.2. Laparoscopic treatment of PCOS has the following advantages: (1) injury and rapid recovery, fewer postoperative adhesions, can replace laparotomy; (2) No ovarian hyperstimulation syndrome and the occurrence of multiple pregnancies; (3) re - several times to facilitate the acceptance of patients. The results of this study showed that laparoscopic treatment of perforated electrocoagulation treatment of PCOS will be more than one ovulation cycle after ovulation rate of 84%, 1.5-year cumulative pregnancy rate 76%, with the traditional effect of ovarian wedge resection is similar to, but the minimally invasive nature of ovarian wedge resection is superior to traditional surgery. This set of data shows that non-ovarian function after premature aging and the occurrence of cases of ovarian atrophy.