Anti-Mullerian hormone levels following laparoscopic ovarian cystectomy with subcutaneous abdominal wall lifting for ovarian endometriomas
Anti-Mullerian hormone levels following laparoscopic ovarian cystectomy with subcutaneous abdominal wall lifting for ovarian endometriomas
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DOI：
10.31083/j.ceog.2021.01.5528
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发表时间：
2021-02-15
影响因子：
0.2
通讯作者：
Nishi, Hirotaka
中科院分区：
文献类型：
--
作者：
Ono, Masataka;Kojima, Junya;Nishi, Hirotaka
研究目的：观察腹腔镜下卵巢子宫内膜异位囊肿行腹壁提升术后抗马勒激素(AMH)水平的变化。材料和方法：这项前瞻性队列研究分析了2014年10月至2016年12月在私立医院和大学医院接受腹腔镜手术的32例子宫内膜异位症患者。我们测量了基线和膀胱切除术后1、3、6和9个月的血液AMH水平。我们还检查了AMH水平与手术时年龄、双侧囊肿、囊肿直径和Douglas窝闭塞的相关性。主要观察指标包括基于AMH水平的卵巢储备。结果：与基线(2.14+/-1.66 ng/m L)相比，术后1个月(1.22+/-1.08 ng/m L)和3个月(1.18+/-1.02 ng/m L)AMH水平显著降低。而术后6个月(1.35+/-1.02 ng/m L)和9个月(1.37+/-0.95 ng/m L)差异无统计学意义。年龄<35岁组(1.10±0.98vs3.15±1.85 ng/mL，P=0.001)、双侧囊肿组(1.58±0.98vs3.15±1.85 ng/mL，P=0.006)、双侧囊肿组(1.16±-0.90vs2.93+/-1.60 ng/mLP=0.002)。结论：腹壁提升术与充气法的AMH水平变化相同，提示两者对卵巢囊肿术后复发和卵巢储备的保护作用是相似的。对子宫内膜异位症患者施行腹腔镜手术时，应积极考虑腹壁提升。如果在术后卵巢储备短暂减少的情况下，卵巢储备仍能长期保留，医生应考虑对这些想要孩子的患者进行手术，并考虑术后人工生殖治疗。
Purpose of investigation: To examine changes in anti-Mallerian hormone (AMH) levels following laparoscopic ovarian endometriotic cystectomy with abdominal wall lifting. Materials and methods: This prospective cohort study analyzed 32 patients with endometriomas who underwent laparoscopic surgery between October 2014 and December 2016 in private and university hospitals. We measured blood AMH levels at baseline and at1,3, 6, and 9 months following a cystectomy. We also examined the correlations of AMH levels with age at time of surgery, bilateral cysts, cyst diameter, and Douglas fossa occlusion. Main outcome measures include the ovarian reserve based on AMH levels. Results: Compared to baseline (2.14 +/- 1.66 ng/mL), AMH levels were significantly reduced at 1 (1.22 +/- 1.08 ng/mL) and 3 (1.18 +/- 1.02 ng/mL) months post-surgery. However, there were no significant differences between baseline and 6 (1.35 +/- 1.02 ng/mL) or 9 (1.37 +/- 0.95 ng/mL) months post-surgery. AMH levels were significantly reduced in patients aged >= 35 years (1.10 0.98 versus 3.15 +/- 1.85 ng/mL, P = 0.001), those with bilateral cysts (1.58 +/- 0.98 versus 3.15 +/- 1.85 ng/mL, P = 0.006), and those with pouch of Douglas occlusion (1.16 +/- 0.90 versus 2.93 +/- 1.60 ng/mL, P= 0.002). Conclusions: Abdominal wall lifting yielded the same AMH level changes as insufflation, suggesting that their effects on recurrence and preservation of the ovarian reserve following ovarian cystectomy are comparable. Abdominal wall lifting should be proactively considered when performing laparoscopic surgery for patients with endometriosis. If the ovarian reserve is preserved in the long term despite transient postoperative reduction in the ovarian reserve, physicians should consider surgery with consideration of postoperative artificial reproductive therapy for these patients who desire to have children.