| Objective: Endometriosis is a common gynecological disease,and the ovarian Endometriosis cyst is the most common,accounting for 14%-47% of Endometriosis.Although Endometriosis is a benign disease,it has a malignant biological behavior,showing a high degree of recurrence and infiltration.At present,the main treatment of Endometriosis is surgery which often damages the ovarian reserve function and reduces the fertility of patients after surgery.In this paper,we analyzed the effect on ovarian reserve function and fertility of the modified laparoscopic cystectomy and the ultrasound-guided puncture in the treatment of ovarian endometriosis cysts through a retrospective study in order to reduce the damage of operation on normal ovarian tissue,reduce the probability of premature ovarian failure,improve the fertility of patients with ovarian endometriosis cysts and optimize the treatment of endometriosis.Methods : From January 2016 to December 2018,cases of ovarian endometriosis cyst with fertility requirements were collected from the Mianyang Central Hospital and the First Affiliated Hospital of Chengdu Medical College.The inclusive criteria:(1)The indication of operation was clear and there was no obvious contraindication to operation,and the pathological diagnosis after operation was clear as ovarian endometriosis cyst;(2)The treatment was the first modified laparoscopic ovarian endometriosis cyst exfoliation or transvaginal ultrasound-guided cyst puncture;(3)The menstrual cycle and ovarian reserve function were normal before operation;(4)The cyst was straight detected by ultrasound before operation The diameter was 4-9cm,and all of them were unilateral;(5)The ovarian function was evaluated regularly after operation,and the patients were followed up regularly after operation;(6)The patients were 20-35 years old,with fertility requirements,all patients and their families signed informed consent;(7)The patients were not combined with other infertility factors before operation.The exclusion criteria:(1)Ovarian cancer;(2)Patients with previous ovarian surgery or hormone therapy;(3)Patients with insulin resistance;(4)Patients with serious heart,brain,liver,kidney,hematopoietic system diseases,endocrine diseases and mental diseases.(5)The patient’s husband was complicated with infertility.There were 70 clinical cases that met the standard.Among them,35 cases were treated by modified laparoscopic cystectomy,which was set as the endoscopic group,35 cases were treated by ultrasound-guided puncture,which was set as the puncture group.The anti-Mullerian hormone(AMH)in peripheral vein blood and the number of follicle count(AFC)in the affected side of ovarian sinuses were measured at 3 months and 6 months after operation by chemiluminescence and transvaginal color Doppler ultrasound.The pain scores of pelvic pain,dysmenorrhea and coital pain were collected by visual analog scale(VAS)before operation,3 months after operation and 6 months after operation.The pregnancy rate and cyst recurrence rate of the two groups within 12 months after operation were compared and analyzed to determine the long-term effect of operation and the improvement of fertility.Results: 1.Three months after operation,AMH value of endoscopic group was 2.249±0.106 ng/ml,and that of puncture group was 3.054±0.025 ng/ml.They were both lower than that before operation.The decrease range of endoscopic group was larger than that of puncture group.There was significant difference between the two groups,P<0.0001,suggesting that the ovarian function of the two groups was damaged at 3 months after operation,and the degree of damage in endoscopic group was more serious.2.After 6 months,AMH value of endoscopic group was 3.605±0.088 ng/ml,and that of puncture group was 3.301±0.098ng/ml.They increased significantly,P<0.0001,suggesting that the ovarian function damage was reversible.At 6 months after operation,AMH value of endoscopic group was higher than that of puncture group,which indicated that the ovarian reserve function of endoscopic group recovered faster.3.Three months after operation,AFC value of endoscopic group was 6.486±1.148,and that of puncture group was 6.971±0.857.the two groups was significantly lower than that before operation,which indicated that the two groups had obvious injury at three months after operation.The decrease was more obvious in endoscopic group,P<0.0001,indicating that the damage was more serious in endoscopic group.4.The AFC value of endoscopic group was 9.571±1.357,and that of puncture group was 8.771±1.942.They increased significantly 6 months after operation,suggesting that the ovarian reserve function of the two groups was improved compared with that of the preoperative.The increase of endoscopic group was larger than that of puncture group,P=0.0006,and there was significant difference between the two groups,suggesting that the recovery of ovarian reserve function of endoscopic group was better than that of puncture group at 6 months after operation.5.The pain scores of endoscopic group was 7.143±2.267(before operation),2.071±2.044(3 months after operation),0.257±0.657(6 months after operation)and that of puncture group was 7.071±2.087(before operation),5.043±2.426(3 months after operation),1.371±1.61(6 months after operation).After the operation,the pain scores of the two groups were significantly reduced,suggesting that after the operation,the patient’s condition was relieved and the pain was controlled.The pain relief in endoscopic group was better than that in puncture group,3 months after operation,P=0.0488,and 6 months after operation,P=0.0497.6.After operation,the pregnancy rate in endoscopic group was 54.29%,and that in puncture group is 25.71%.It was higher in endoscopic group,with significant difference,P=0.027,suggesting that the protection of fertility in endoscopic group was better than that in puncture group.7.The recurrence rate of endoscopic group was 5.71%,and that of puncture group was 25.71%.The recurrence rate of puncture group was significantly higher than that of endoscopic group,P=0.045,indicating that the long-term effect of endoscopic group was better than that of puncture group.8.The operation time of endoscopic group was 70.571±10.452,and that of puncture group was 34.514±5.414.The operation time of puncture group was significantly lower than that of endoscopic group,P=0.0002,indicating that the puncture group had an advantage in the operation time.Conclusion: In the treatment of ovarian endometriosis cyst,both of modified laparoscopic cystectomy and ultrasound-guided puncture therapy will reduce ovarian reserve function.From the experimental results,the recovery of ovarian reserve function was faster in endoscopic group,and it could return to the preoperative level about 6 months after operation.The endoscopy group can preferably relieve pain,improve fertility,has better long-term effect and lower recurrence rate.In puncture group,the operation time was short,and there were also advantages of small trauma,simple operation and low cost.Both of them have their own advantages.In clinical work,we should choose the appropriate treatment according to the actual situation of patients. |
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