Influence on the ovarian reserved function of Gn-RH injection in the bilateral laparoscopic cystectomy / 局解手术学杂志

Objective To investigate the influence on the ovarian reserved function of Gn-RH injection in the bilateral laparoscopic cys-tectomy. Methods The clinical data of 100 patients with endometriosis undergoing bilateral laparoscopic cystectomy were included in this study. 50 patients treated by routine bilateral laparoscopic cystectomy were set as control group. 50 patients treated by Gn-RH injection addi-tionally during the surgery were set as study group. The operative situation,serum FSH level,FSH/LH,E2 level,ovarian reserved function, pregnancy situation and recurrent rate were compared between two groups. Results The operative duration and electrocautery times in study group was significantly less than those in control group(P<0. 01). The residual ovarian tissue capsule wall thickness in study group was sig-nificantly more than that in control group(P<0. 01). At different time points,the serum FSH level,FSH/LH and E2 level in study group were significantly less than those in control group(P<0. 01,P<0. 05). The incidence of ovarian reserved function damage in study group was significantly less than those in control group(P<0. 05). The pregnancy rate was significantly higher and the time between surgery and pregnancy was significantly shorter in study group than those in control group(P<0. 05,P<0. 01). The recurrent rate in study group was sig-nificantly less than those in control group(P<0. 01). Conclusion There is a influence on ovarian reserved function of bilateral laparoscopic cystectomy. By inject Gn-RH during surgery,the ovarian reserved function could be protected,which increase the pregnancy rate and reduce recurrence.

Surgical impact on serum anti-Mullerian hormone in women with benign ovarian cyst: A prospective study

OBJECTIVE: The aim of this study was to evaluate the surgical impact of benign ovarian mass on ovarian reserve as measured by serum follicle stimulating hormone (FSH), estradiol (E2) and anti-Mullerian hormone (AMH) levels, antral follicle count (AFC) and ovarian volumes. In addition, the differences in ovarian reserve impairment between endometrioma cystectomy and non-endometrioma cystectomy were investigated. METHODS: In this prospective study, 22 patients of reproductive age (range, 18.35 years) with benign ovarian masses were enrolled to undergo laparoscopic cystectomy. Of whom 12 had endometriomas and 10 had non-endometriomas. On early follicular phase (day 3) of the cycle preceding the operation and three months after the laparoscopic cystectomy, serum levels of FSH, E2 and AMH, AFC and ovarian volumes were measured in all patients. Data were analyzed with Mann-Whitney U-test and Wilcoxon rank test using SPSS ver. 12.0 for statistic analysis. RESULTS: Median level of serum AMH was significantly decreased from 5.48 ng/mL (interquartile range [IQR], 2.80-7.47) before cystectomy to 2.56 ng/mL (IQR, 1.74-4.32) 3 months postoperation (P<0.05). On the other hand, no significant differences in FSH, E2, AFC and ovarian volumes were found between the preoperative and three months postoperative levels. In a subgroup analysis of the pathologic type of the ovarian cyst, postoperative serum AMH levels were significantly decreased in the endometrioma group, but not in the non-endometrioma group. CONCLUSION: Serum AMH levels were significantly decreased after laparoscopic cystectomy without any changes of other ovarian reserve tests.

Surgical treatment of ovarian dermoid cysts: a clinical evaluation between vaginal and laparoscopic removal / 대한산부인과학회지

OBJECTIVE: This study was conducted to compare the results between vaginal and laparoscopic removal for surgical treatment of ovarian dermoid cysts. METHODS: This retrospective study was performed in 228 patients, who underwent vaginal (Group A: 159) or laparoscopic (Group B: 69) removal of ovarian dermoid cysts between January 1998 and May 2004. The vaginal removal was performed after reduction of mass size by suction of its contents, and laparoscopic removals with Lapbag(R). RESULTS: The mean age was 37.7 +/- 9.7 years in Group A and 30.5 +/- 9.2 years in Group B. The number of patients had a previous abdominal open surgery was 30 (17.8%) in Group A and 15 (21.7%) in Group B. The mean diameter of the ovarian dermoid cysts was 6.1 +/- 2.1 cm in Group A and 5.7 +/- 2.0 cm in Group B. The differences between preoperative and postoperative hemoglobin was 1.8 +/- 1.4 g/dL in Group A and 1.5 +/- 0.8 g/dL in Group B (p<0.05). Operating time was 34 +/- 16 minutes in Group A and 82 +/- 36 minutes in Group B (p<0.01). The number of patients had febrile morbidity (greater than 38 degrees C 24h after surgery) was 3 (1.7%) in Group A and 2 (2.8%) in Group B. The feeling of satisfaction was very high in both groups. CONCLUSION: Both vaginal and laparoscopic removal of ovarian dermoid cysts are useful and effective treatment. However, the vaginal removal have cheap hospital expenses, shorter operating time, and no surgical trauma on abdominal wall. So, it have great advantages compare with laparoscopic removal. Vaginal removal can be considered a useful alternative procedure.

The Efficacy of GnRH Analogue on Pain Treatment after Laparoscopic Cystectomy of Endometrioma / 대한산부인과학회잡지

OBJECTIVE: To estimate the efficacy of GnRH analogue on pain treatment after laparoscopic cystectomy of endometrioma. METHODS: During a 12-month period from March 2000 to February 2001 in Chonnam National University Hospital, Sixty five patients with ovarian cysts were diagnosed as endometrioma by clinical examination, ultrasonogram and serum CA 125 level. The laparoscopic cystectomy was performed and 65 consecutive women were biopsy-proved endometrioma. They were treated with GnRH analogue intramuscular injection every 4 weeks over a period of 6 months after operation. 10-point linear visual analogue scales for pelvic pain were completed pre- and post- treatment at 6 months and 12 months. RESULTS: A total of 96 endometriotic cysts (21 cysts were bilateral) were found in the 65 patients. 65 patients had a pain associated with endometriosis. 40 patients of them complained of a dysmenorrhea, 14 patients for dyspareunia, and 24 patients for non-menstrual pain. At preoperative, the mean pain score was 5.85 +/- 2.28 (mean +/- SD) for dysmenorrhea; for dyspareunia, 5.29 +/- 1.49; for non-menstrual pain, 5.33 +/- 2.10. At 6 months and 12 months, the mean pain score was 3.20 +/- 1.68 and 2.42 +/- 1.9 for dysmenorrhea; for dyspareunia, 3.71 +/- 1.73 and 3.57 +/- 1.79; for non-menstrual pain, 3.63 +/- 2.26 and 3.29 +/- 1.97. The mean pain score for pelvic pain decreased after combined treatment. CONCLUSION: The laparoscopic cystectomy of ovarian endometrioma is an effective treatment for pelvic pain and the combination therapy with GnRH analogue is more useful to relieving pelvic pain after operation.