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Objective To investigate the expression of anti mullerian hormone(AMH)in the serum of patients with ovarian endometriosis cyst and its clinical significance.Methods Fifty-one cases of ovarian endometriosis cyst from March 2014 to June 2016 in Maternal and Child Health Hospital Affiliated to Southern Medical University(observation group)and thirty-five cases of normal women who were diagnosed through physical examination(control group)were selected as the research objects.The observation group patients received laparoscopic ovarian endometriosis cystectomy treatment,enzyme-linked immunosorbent assay(ELISA) was applied to detect and analyze serum AMH in the control group at physical examination and in the observation group before surgery and at 1 month,3 months after surgery.Results (1)The preoperative serum AMH level of the observation group was significantly lower than that of the control group,the difference was statistically significant((2.45±0.68)μg/L vs.(3.75±0.80)μg/L,t=7.8604,P=0.0000).(2)Serum AMH level in the groups where the ages were above 35years was significantly lower than that of the age less than 35 group( (1.76±0.57)μg/L vs.(3.61±0.88)μg/L,t=9.1249,P=0.0000); the preoperative serum AMH level in the group where disease course was more than 12 months was significantly lower than that of the disease course less than 12 months group((2.03 ± 0.64)μg/L vs.(3.98 ± 0.91)μg/L,t=8.1408,P=0.0000); the preoperative serum AMH level in patients with dysmenorrhea was significantly lower than that of patients without dysmenorrhea((1.65±0.53)μg/L vs.(3.91±0.84)μg/L,t=11.7861,P=0.0000),the preoperative serum AMH level in the bilateral lesion group was significantly lower than that of the unilateral lesion((2.01±0.68) μg/L vs.(2.84±0.72)μg/L,t=4.2174,P=0.0001); there was no significant difference in the preoperative serum AMH level between patients with<5.0 cm diameter cyst and patients with smaller cyst((2.52 + 0.81)μg/L vs.(2.39 + 0.50)μg/L,t=0.8411,P=0.4029).The serum AMH level in the observation group at 3 months after surgery was significantly lower than that before surgery((2.45±0.68)μg/L vs.(1.81± 0.55) μg/L,t=24.3657,P=0.0000).Conclusion The expression of serum AMH level in patients with ovarian endometriosis is low,and it is closely related to the age,course of disease,history of dysmenorrhea and the location of the lesion.Laparoscopic ovarian cystectomy may reduce ovarian reserve capacity in patients with ovarian endometriosis.
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Objective To study clinical effect of laparoscopy combined with gestrinone in treatment of ovarian endometriosis cyst and the prognoisi of patients. Methods A randomized, controlled, prospective study was used in this study, 78 patients with ovarian endometriosis cyst were selected in Sichuan province panzhihua city miyi people's hospital from august 2012 to august 2014, and were randomly divided into observation group and control group, 39 patients in each group. Patients in the observation group were treated with laparoscopy combined with gestrinone (2.5 mg/time, two times per week, for 6 months) intervention; patients in the control group were treated with laparoscopic intervention. After six months, the postoperative serum FSH (Follicle Stmi Ulating Hormone, FSH), Estradiol (E2) and Estradiol levels, ovarian biggest plane average diameter (D), the level of MMP-9 and TIMP -1 level, pregnancy outcome of two groups were compared and the outcome and the recurrence rate 18 months after treatment were followed up. Results Six months after treatment, the E2 and FSH levels in the observation group were better than control group, with statistically significant difference (P2 cm, the postoperative ovarian shrink rate was 51.28% in the observation group; there were 5 patients of D≤2 cm, 34 patients of D>2 cm ovarian shrink ratio was 12.82% in the control group, the ovarian shrink ratio of observation group was obviously higher than control group, with statistically significant difference (P<0.01) . Follow-up for 18 months, the recurrence rate was 5.13%in the observation group, which was significantly lower than thatin the control group (25.64%), with statistically significant difference (P<0.05);the pregnancy rate was 66.66%and 30.77%in the Observation group and control group, respectively, the difference had statistical significance (P<0.01) . Conclusion Laparoscopic surgery combined with gestrinone can protect ovarian function of patients with ovarian endometriosis cyst, improve pregnancy outcomes, and reduce recurrence rate, and has good clinical value.
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Objective To compare the curative effects of CT-guided ethanol injection and lauromacrogol injection into the sac cavity in treating ovarian endometriosis cysts. Methods A total of 86 patients with ovarian endometriosis cyst were enrolled in this study. The patients were divided into ethanol group (n=44) and lauromacrogol group (n=42). Under CT guidance, injections of ethanol or lauromacrogol into the sac cavity of ovarian endometriosis cysts were respectively performed for the patients of both groups. The patients were followed up for six months, and the curative effects and the complications were analyzed. Results Six months after the treatment, the cure rates of ethanol group and lauromacrogol group were 95.50%and 92.86%respectively, and no statistically significant difference in cure rate existed between the two groups (P>0.05). The preoperative serum CA125 levels of the ethanol group and lauromacrogol group were (48.42±23.68)μg/L and(49.21±22.83) μg/L respectively, and the post operative ones were (23.56±5.89) μg/L and (25.49± 6.10) μg/L respectively; the differences between the preoperative data and the postoperative data were statistically significant in both groups (P0.05). The incidence of postoperative complications in the lauromacrogol group was obviously lower than that in the ethanol group (P<0.05). The cure time in the ethanol group was shorter than that in the lauromacrogol group, although the difference was not significant after six months. Conclusion For the treatment of ovarian endometriosis cysts, CT-guided lauromacrogol injection into the sac cavity has reliable curative effect. Compared to ethanol injection, injection of lauromacrogol is safer and has fewer adverse reactions. Therefore, this technique should be recommended in clinical practice. Serum CA125 can be used as an indicator for the evaluation of curative effect.
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s:Objective To explore the anatomical distribution characteristics of pelvic endometriosis lesion, size of the cyst, tissue ad-hesion degree and the correlation with the pain symptoms in patients with ovarian endometriosis cyst. Methods 342 cases of patients with o-varian endometriosis cyst who has underwent gynecologic laparoscopic surgical treatment in our hospital were selected as the research objects. According to the pain symptoms, they were divided into the pain group (195 cases) and the painless group (147 cases). The influence of cyst growth area and size on the pain symptoms were compared, and whether there were cyst adhesion and the relationship between adhesion area and pain were analyzed. Results The operation time of pain group was longer. The average operation time was 81. 2 min in pain group while it was 62. 1 min in painless group. The bleeding volum was 74. 3 mL in pain group which was higher than 56. 2 mL in the painless group. The average diameter of cyst was 11. 26 cm in the Pain group, and it was 6. 10 cm painless group. Rate of adhesions in patients of pain group was significantly higher than that of the painless group. Adhesion occured most frequently in ovary, followed by the fallopian tubes. Conclusion Pain symptoms have a close relation with cyst diameter and degree of surrounding tissue adhesion. As the cyst diameter get larger and the surrounding tissue adhesions grow broader, the pain symptoms would be more significant in patients .
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Objective To compare effects between laparoscopy and laparotomy for the treament of ovarian endometriosis cysts and to investigate the value of laparoscopy in the treatment of ovarian endometriosis cysts. Methods We retrospectively analyzed 144 cases of ovarian endometriosis cysts,92 of which underwent laparoscopic operations(Laparoscopic Group) and 52 of which received open operations(Open Group).All the cases were followed for 4 months ~ 5 years.Results The operation time,postoperative hospital stay,and intraoperative blood loss were 69?41.8 min,3.5?1.0 d,and 55?12.0 ml in the Laparoscopic Group,respectively,and 137?54.3 min,8.7?3.5 d,and 178?105.9 ml in the Open Group,respectively,with significant differences between the two groups(t=-8.402,-11.048,and-13.350;P=0.000).There was no significant difference in the rate of abdominal pain relief between the Laparoscopic Group(66.0%,35/53) and the Open Group(52.8%,19/36)(?~2=1.580,(P=0.209)).The recurrent rate was 19.6%(18/92) in the Laparoscopic Group and 19.2%(10/52) in the Open Group,without significant difference between the two groups(?~2=0.002,P=0.961). Conclusions Laparoscopic surgery gives similar efficacy to open surgery in the treatment of ovarian endometriosis cysts.Laparoscopic surgery can be used as the first choice in treating ovarian endometriosis cysts because of its minimally invasive characteristics.
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Objective To evaluate the mid-long term effects of laparoscopic treatment of ovarian endometriosis cysts.Methods Clinical data of 209 cases of ovarian endometriosis cysts treated by laparoscopic operation from January 2002 to December 2005 were retrospectively analyzed.All the patients were followed for at least 12 months(12-54 months).There were 115 cases of unilateral ovarian cyst enucleation,62 cases of bilateral enucleation,11 cases of unilateral adnexectomy,and 21 cases of unilateral adnexectomy combined with contralateral cyst enucleation.Oral gestrinone was administrated in patients without childbearing intentions,while in patients demanding a child,no drug was given and an early pregnancy was encouraged.Results Conversions to open surgery were required in 7 cases.No complications occurred.Ovarian endometriosis cysts recurred in 17 cases(8.1%),including 7 cases of stage Ⅲendometriosis and 10 cases of stage Ⅳ endometriosis.Of the 35 cases of infertility,intrauterine pregnancy was obtained in 16 cases,with a pregnancy rate of 45.7%.The pregnancy occurred at 4-29 months after operation(within 2 years in 10 cases).Of the 157 cases of dysmenorrhea,a complete relief was achieved in 95 cases(60.5%)and an improvement was obtained in 62 cases(39.5%).Conclusions Laparoscopic treatment is suitable for all stages of ovarian endometriosis cysts.Postoperative drug administration and long-term follow-up are necessary to lower the recurrence rate.