腹腔鏡卵巢電灼鑽孔

 

 

權威的生殖期刊 Human Reproduction

2011 May 15 搶鮮版

 

 

長期追蹤在多囊性卵巢症候群患者最初隨機接受腹腔鏡卵巢電灼鑽孔或促性腺激素(排卵針)誘導排卵的結果

來源

 

荷蘭阿姆斯特丹大學。

摘要

背景:

腹腔鏡電灼卵巢對多囊性卵巢症候群患者的長期影響(生殖能力)不明。為了研究克羅米芬(口服排卵藥)抗拒(無效)的多囊性卵巢症候群（PCOS）患者接受腹腔鏡卵巢電灼和促性腺激素的長期影響，我們追蹤婦女克羅米芬(口服排卵藥)抗拒(無效)的多囊性卵巢症候群患者（PCOS）患者隨機分配到這兩種治療，直到8-12年後。

 

方法:

1998年2月至2001年10月168婦女與克羅米芬(口服排卵藥)抗拒(無效)的多囊性卵巢症候群(PCOS）患者在一項隨機對照試驗比較了卵巢電灼鑽孔與 rFSH促性腺激素(排卵針)刺激排卵的策略。這些婦女在2009年進行了聯繫，對他們的生育和月經週期規律的結果。分析採用意向性治療。我們比較活產，隨後懷孕，子宮外孕和多次懷孕，更年期，以及最小和最大的月經週期的長短。結果經過 8-12年來，累計比例的婦女生下第一個孩子的婦女為電灼組 :86％，與促性腺激素(排卵針)組:81％的婦女 [相對比（RR）：1.1; 95％可信區間（CI）：0.92-1.2]。53%電灼治療產生了顯著降低需要(排卵針)刺激週期以達到活產，比上直接使用促性腺激素(排卵針)76％（RR：0.69; 95％信賴區間：0.55-0.88）。累計婦女生第二胎的比例為 61％比46％（相對比：1.4; 95％CI為：1.00-1.9）。總體而言，電灼組有7對雙胞胎生出134（5％）與促性腺激素(排卵針)組有10對雙胞胎生出，(8％）（RR：0.65; 95％CI為：0.25-1.6）。電灼組直到8-12年後有54%的女性有規律的月經週期，相較於rFSH促性腺激素(排卵針)刺激排卵組有36％的女性有規律的月經週期（相對比：1.5; 95％CI為：0.87-2.6）。

 

結論:

在克羅米芬(口服排卵藥)抗拒(無效)的多囊性卵巢症候群（PCOS）患者，腹腔鏡卵巢電灼和使用促性腺激素(排卵針)者是一樣是有效的生活產嬰兒，相較於使用促性腺激素(排卵針)者，腹腔鏡卵巢電灼減少了需要誘導排卵或人工生殖中的比例以增加機會生下第二胎活產的機會。不孕症醫生可以使用這些數據諮詢克羅米芬(口服排卵藥)抗拒(無效)的多囊性卵巢症候群（PCOS）患者的治療方案

 

PS: 以上論點為文獻報告，不代表陳啟煌醫師或國內醫師的共識或作法。全世界反對燒灼鑽孔卵巢以治療克羅米芬(口服排卵藥)抗拒(無效)的多囊卵巢綜合徵（PCOS）患者的醫師仍然很多。

 

 

 

Hum Reprod. 2011 May 15. [Epub ahead of print]

Long-term outcomes in women with polycystic ovary syndrome initially randomized to receive laparoscopic electrocautery of the ovaries or ovulation induction with gonadotrophins.

Nahuis MJ, Kose N, Bayram N, van Dessel HJ, Braat DD, Hamilton CJ, Hompes PG, Bossuyt PM, Mol BW, van der Veen F, van Wely M.

Source

Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

 

Abstract

BACKGROUND Long-term effects of laparoscopic electrocautery of the ovaries are unknown. To study the long-term effects of laparoscopic electrocautery of the ovaries and gonadotrophins, we followed women with clomiphene-resistant polycystic ovary syndrome (PCOS) randomly allocated to one of these treatments until 8-12 years after their initial treatment. METHODS Between February 1998 and October 2001 168 women with clomiphene citrate-resistant PCOS were included in a randomized controlled trial comparing an electrocautery strategy to a strategy starting with rFSH. In 2009 these women were contacted about their reproductive outcome and menstrual cycle regularity. Analysis was by intention-to-treat. We compared time to conception resulting in live birth, subsequent pregnancies, ectopic and multiple pregnancies, menopause, as well as minimal and maximal menstrual cycle length. RESULTS After 8-12 years, the cumulative proportion of women with a first child was 86% in women who had been allocated to electrocautery versus 81% in women who had been allocated to immediate rFSH [relative ratio (RR): 1.1; 95% confidence interval (CI): 0.92-1.2]. Treatment with electrocautery resulted in a significantly lower need for stimulated cycles to reach a live birth; 53% after electrocautery versus 76% after rFSH (RR: 0.69; 95% CI: 0.55-0.88).The cumulative proportion of women with a second child was 61% after electrocautery versus 46% after immediate rFSH (RR: 1.4; 95% CI: 1.00-1.9). Overall, there were 7 twins out of 134 deliveries (5%) after electrocautery versus 10 twins out of 124 deliveries (8%) in the rFSH group (RR: 0.65; 95% CI: 0.25-1.6). Fifty-four per cent of the women allocated to electrocautery had a regular menstrual cycle 8-12 years after randomization versus 36% in those allocated to rFSH (RR: 1.5; 95% CI: 0.87-2.6). CONCLUSION In women with clomiphene-resistant PCOS, laparoscopic electrocautery of the ovaries is as effective as ovulation induction with FSH treatment in terms of live births, but reduces the need for ovulation induction or ART in a significantly higher proportion of women and increases the chance for a second child. Clinicians may use these data when informing clomiphene-resistant anovulatory women about treatment options