卵巢子宫内膜异位囊肿不孕患者单孔腹腔镜乙醇硬化法和腹腔镜剥离后的IVF妊娠结局比较

凤 王(深圳市恒生医院生殖医学中心科，中国)
亚梅 李(深圳市恒生医院生殖医学中心科，中国)
华玲 汪(深圳市恒生医院生殖医学中心科，中国)
兰娥 黄(深圳市恒生医院生殖医学中心科，中国)
伟芬 邓(深圳市恒生医院生殖医学中心科，中国)

摘要

目的：回顾性分析比较卵巢子宫内膜异位囊肿（OEA）单孔腹腔镜乙醇硬化疗法（SLES）和腹腔镜卵巢囊肿剥离术（LOCR）的疗效和体外受精-胚胎移植后的妊娠结局。方法：收集我院生殖中心接受OEA手术后行IVF-ET治疗的患者50例，根据手术方式不同分为LOCR（n=25例）和SLES（n=25例）2组，比较两组患者的术后临床改变及辅助妊娠结局。结果：两组患者年龄、AMH、窦卵泡计数（AFC）等基本指标比较，差异均无统计学意义（P ＞ 0.05）。术后LOCR组AMH水平明显低于SLES组（P＜0.05）。SLES组MII数、2PN数、可利用胚胎数和优质胚胎数、临床妊娠率均显著高于LOCR组（P ＜ 0.05）。两组生化妊娠率和流产率相似。结论：SLES具有对卵巢储备影响较小的优势，可提高OEA术后患者的IVFET周期妊娠率。

关键词

卵巢子宫内膜异位囊肿；体外受精胚胎移植（IVF-ET）；单孔腹腔镜；乙醇硬化疗法；不孕症

参考

Stefano Angioni, Üzeyir Kalkan, Adrien Crestani, Benjamin Merlot, Horace Roman. Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J Clin Med. 2023;12(16): 5324.

Frankowska K, Dymanowska-Dyjak I, Abramiuk M, Polak G. The Efficacy and Safety of Transvaginal Ethanol Sclerotherapy in the Treatment of Endometrial Cysts-A Systematic Review. Int J Mol Sci. 2024;25(2):1337.

Miquel L, Preaubert L, Gnisci A, Resseguier N, Pivano A, Perrin J, Courbiere B. Endometrioma ethanol sclerotherapy could increase IVF live birth rate in women with moderate-severe endometriosis. PLoS One. 2020;15(9):e0239846.

Horne AW, Missmer SA. Pathophysiology, Diagnosis, and Management of Endometriosis. BMJ. 2022;379:e070750.

Vaduva CC, Dira L, Carp-Veliscu A, Goganau AM, Ofiteru AM, Siminel MA. Ovarian reserve after treatment of ovarian endometriomas by ethanolic sclerotherapy compared to surgical treatment. Eur Rev Med Pharmacol Sci. 2023;27(12):5575-5582.

Antonaci D, Schiavi MC, Carletti V, Yacoub V, Morgani C, Grilli D, Galanti F, Ligato A, Valensise HC, Palazzetti P, Rago R. Laparoscopic stripping versus endometrioma ethanol sclerotherapy in women with endometrioma awaiting IVF: a long-term analysis of ovarian reserve and pregnancy outcome. Minerva Obstet Gynecol. 2022;74(5):410-418.

Yang C, Geng Y, Li Y, Chen C, Gao Y. Impact of ovarian endometrioma on ovarian responsiveness and IVF: A systematic review and meta-analysis. Reprod Biomed Online. 2015;31:9–19.

Muzii L., Di Tucci C., Di Feliciantonio M., Galati G., Di Donato V., Musella A., Palaia I., Panici P.B. Antimüllerian hormone is reduced in the presence of ovarian endometriomas: A systematic review and meta-analysis. Fertil. Steril. 2018;110:932–940.

Uncu G., Kasapoglu I., Ozerkan K., Seyhan A., Yilmaztepe A.O., Ata B. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum. Reprod. 2013;28:2140–2145.

Goodman L.R., Goldberg J.M., Flyckt R.L., Gupta M., Harwalker J., Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am. J. Obstet. Gynecol. 2016;215:589.e1–589.e6.

Miquel L, Preaubert L, Gnisci A, Netter A, Courbiere B, Agostini A, Pivano A: Transvaginal ethanol sclerotherapy for an endometrioma in 10 steps. Fertil Steril 2021, 115:259-60.

Tian Z, Zhang Y, Zhang C, Wang Y, Zhu H.-L. Antral Follicle Count Is Reduced in the Presence of Endometriosis: A Systematic Review and Meta-Analysis. Reprod. BioMedicine Online. 2021;42:237–247.

Benaglia L, Busnelli A, Biancardi R, Vegetti W, Reschini M, Vercellini P, et al. Oocyte retrieval difficulties in women with ovarian endometriomas. Reprod Biomed Online. 2018;37(1):77–84.

Gupta S, Agarwal A, Agarwal R, Loret de Mola JR. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online. 2006. September;13(3):349–60.

Becker C.M., Bokor A., Heikinheimo O., Horne A., Jansen F., Kiesel L., King K., Kvaskoff M., Nap A., Petersen K., et al. ESHRE Guideline: Endometriosis. Human Reprod Open. 2022;2022:hoac009.

Mohtashami S, Jabarpour M, Aleyasin A, Aghahosseini M, Najafian A: Efficacy of Ethanol Sclerotherapy Versus Laparoscopic Excision in the Treatment of Ovarian Endometrioma. J Obstet Gynaecol India 2024, 74:60-6.

Coccia ME, Rizzello F, Barone S, Pinelli S, Rapalini E, Parri C, Caracciolo D, Papageorgiou S, Cima G, Gandini L. Is there a critical endometrioma size associated with reduced ovarian responsiveness in assisted reproduction techniques? Reprod Biomed Online. 2014;29(2):259-66.

Filippi F, Benaglia L, Paffoni A, Restelli L. Vercellini P, Somigliana E, Fedele L. Ovarian endometriomas and oocyte quality: Insights from in vitro fertilization cycles. Fertil Steril. 2014;101:988–993.

Wan L, Zhao Q, Chen J, et al. Consensus of Chinese Experts on the Application of Pain Assessment Scales (2020) Edition [J]. Chinese Journal of Pain Science, 2020,16(3):177-187.

Crestani A, Merlot B, Dennis T, Roman H. Laparoscopic Sclerotherapy for an Endometrioma in 10 Steps. Fertil. Steril. 2022;117:1102–1103.

Wang F, Deng WF, Wang S, Li XL, Shen L. Clinical effect of absolute alcohol solidification in ovarian chocolate cyst combined with modified supper long protocol in patients with endometriosis. Clinical Medical Research and Practice (Chinese). 2017; 2:1-6.

Goldberg JM, Falcone T, Diamond MP. Current controversies in tubal disease, endometriosis, and pelvic adhesion. Fertil Steril. 2019;112(3):417–25.

Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(9):3146–54.

Ghasemi Tehrani H, Tavakoli R, Hashemi M, Haghighat S. Ethanol Sclerotherapy versus Laparoscopic Surgery in Management of Ovarian Endometrioma; a Randomized Clinical Trial. Arch Acad Emerg Med. 2022;10(1):e55.

Deckers P, Ribeiro SC, Simoes RDS, Miyahara C, Baracat EC. Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve. Int J Gynaecol Obstet. 2017;140(1):11–7.

Mostaejeran F, Hamoush Z, Rouholamin S. Evaluation of antimullerian hormone levels before and after laparoscopic management of endometriosis. Adv Biomed Res. 2015:4. doi: 10.4103/2277-9175.

Huang L, Chang M-Y, Shiau C-S. Changes in anti-müllerian hormone after ultrasound guided aspiration and ethanol sclerotic therapy of ovarian cyst. Taiwan J Obstet Gynecol. 2021;60(3):509–12.

Singh SS, Suen MW: Surgery for endometriosis: beyond medical therapies. Fertil Steril 2017, 107:549-54.

Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG. Coagulation or excision of ovarian endometriomas? Am J Obstet Gynecol. 2003;188:606-10.

Xu HX, Wang WP, HB, et al. Chinese expert consensus on ultrasound-guided sclerotherapy for ovarian endometriotic cysts. Chinese Journal of Ultrasonography. 2020;29:1013-1024.

Yazbeck C, Koskas M, Cohen Scali S, Kahn V, Luton D, Madelenat P. [How I do… ethanol sclerotherapy for ovarian endometriomas]. Gynécologie Obstétrique Fertil. 2012. Oct;40(10):620–2.

Lee K-H, Kim C-H, Lee Y-J, Kim S-H, Chae H-D, Kang B-M. Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma. Obstet Gynecol Sci. 2014. July;57(4):297–303.

Guo Y, Lu N, Zhang Y, Su Y, Wang Y, Zhang Y, et al. Comparative study on the pregnancy outcomes of in vitro fertilization-embryo transfer between long-acting gonadotropin-releasing hormone agonist combined with transvaginal ultrasound-guided cyst aspiration and long-acting gonadotropin-releasing hormone agonist alone. Contemp Clin Trials. 2012;33(6):1206–10.

Antonaci D, Schiavi MC, Carletti V, Yacoub V, Morgani C, Grilli D, Galanti F, Ligato A, Valensise HC, Palazzetti P, Rago R. Laparoscopic stripping versus endometrioma ethanol sclerotherapy in women with endometrioma awaiting IVF: a long-term analysis of ovarian reserve and pregnancy outcome. Minerva Obstet Gynecol. 2022;74(5):410-418.

Borghese B, Marzouk P, Santulli P, de Ziegler D, Chapron C. Surgical treatments of presumed benign ovarian tumors. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):786-93.

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v8i4.25545