不同卵泡抽吸治疗模式对氯米芬抵抗多囊卵巢综合征的疗效

目的比较2种不同模式的卵泡抽吸术（follicular aspiration,FA）对氯米芬（clomifene citrate,CC）抵抗型多囊卵巢综合征（polycystic ovary syndrome,PCOS）不孕的治疗效果。方法2005年12月-2007年12月,将85例CC抵抗PCOS不孕症分为2组,均在经阴道超声（transvaginal ultrasound,TVU）介导下手术。组Ⅰ为彻底手术组30例,即抽吸所有卵泡;组Ⅱ为常规组38例,仅抽吸较大的卵泡。通过TVU和激素水平的检测,分析两种治疗模式对患者内分泌、排卵率和妊娠率的影响。结果组Ⅰ累积排卵率和妊娠率均优于组Ⅱ83.3%（25/30）vs42.1%（16/38）,χ2=11.903,P=0.001;43.3%（13/30）vs13.2%（5/38）,χ2=7.843,P=0.005],组Ⅰ术后黄体生成素和睾酮水平较术前明显下降（17.68±3.11）vs（11.58±1.84）,t=9.220,P=0.000;（3.41±2.14）vs（1.47±1.29）,t=3.937,P=0.000],而组Ⅱ无明显改善（17.76±4.51）vs（16.11±3.53）,t=0.229,P=0.062;（3.88±1.54）vs（3.72±1.27）,t=0.995,P=0.326]。结论彻底穿刺抽吸所有小卵泡能明显改善CC抵抗型PCOS不孕患者的内分泌状况,有效提高排卵率和妊娠率。

Therapeutic Effects of Different Approaches for Transvaginal Ultrasound-Guided Follicular Aspiration in Infertile Patients with Clomiphene Citrate-Resistant Polycystic Ovary Syndrome

Objective To compare the effectiveness of two different modes of follicular aspiration（FA）guided by transvaginal ultrasound（TVU）in infertile patients with clomiphene citrate（CC）-resistant polycystic ovary syndrome（PCOS）.Methods From December 2005 to December 2007,85 patients with CC-resistant PCOS were randomly divided into two groups.Group Ⅰ（thorough treatment）had the every possible small follicles being punctured and aspirated,while group Ⅱ（routine operation）only had the larger follicles being operated.These patients were monitored with TVU and testing the steroid hormone levels.The effect of the two methods on the hormone levels and rates of ovulation and pregnancy were analyzed.Results After the treatments,the cumulative rates of ovulation and pregnancy in the group Ⅰ were higher than those in the group Ⅱ 83.3%（25/30）vs 42.1%（16/38）,χ2=11.903,P=0.001;43.3%（13/30）vs 13.2%（5/38）,χ2=7.843,P=0.005].Moreover,the levels of luteinizing hormone（LH）and testosterone（T）were decreased significantly after the treatment in group Ⅰ （17.68±3.11）vs（11.58±1.84）,t=9.220,P=0.000;（3.41±2.14）vs（1.47±1.29）,t=3.937,P=0.000],whereas those in group Ⅱ were not improved markedly （17.76±4.51）vs（16.11±3.53）,t=0.229,P=0.062;（3.88±1.54）vs（3.72±1.27）,t=0.995,P=0.326].Conclusions Thorough treatment that has the every possible small follicle being punctured and aspirated can significantly improve the endocrinological abnormalities,and increase the rates of ovulation and pregnancy in patients with CC-resistant PCOS.