【摘要】 目的:探讨氯米芬抵抗多囊卵巢综合征(PCOS)患者腹腔镜卵巢打孔内凝术(LOD)治疗后催乳素(PRL)水平的变化及其与排卵的关系。方法:对60例氯米芬抵抗PCOS患者采用LOD手术,术后分成两组,每组30例,一组术后24h后应用溴隐亭治疗,作为治疗组;另一组不治疗,即未治疗组;另选取30例有排卵周期的不明原因不孕症患者,对她们施行了诊断性腹腔镜手术,作为对照组。检测3组患者术后卵巢激素的变化,特别是PRL水平的变化,并比较两组PCOS患者术后卵泡发育和排卵情况。结果:①未治疗组患者同对照组相比,术前、术后24h及术后1周的PRL水平没有明显的变化;而术后首次月经周期后的窦卵泡期的PRL水平相比,PCOS组明显高于对照组,差异有统计学意义(P<0.05)。②治疗组患者同对照组相比,术前、术后24h、术后1周及术后首次月经周期后的窦卵泡期的PRL水平没有明显的变化,差异无统计学意义(P>0.05)。③未治疗组排卵和不排卵患者相比,排卵患者PRL水平明显低于不排卵患者;而排卵者的卵泡明显大于不排卵者,差异有统计学意义(P<0.01)。④治疗组排卵和不排卵患者相比,排卵患者PRL水平也明显低于不排卵患者;而排卵者的卵泡也明显大于不排卵者,差异有统计学意义(P<0.01)。⑤治疗组与未治疗组患者排卵情况相比,治疗组排卵率明显高于未治疗组,差异有统计学意义(P<0.05)。结论:氯米芬抵抗PCOS患者LOD术后的首次月经周期后的窦卵泡期有PRL水平升高的现象,PRL的升高是导致术后短期内卵泡发育异常和不排卵的一个主要原因;术后24h后应用溴隐亭治疗能有效的防治PRL水平升高所导致的卵泡发育异常和不排卵,可以成为PCOS患者术后的一个常规治疗选择。更多还原

【Abstract】 Objective:To explore the relationship between changes of prolactin(PRL)levels after laparoscopic ovarian drilling(LOD)and ovulation in patients with clomiphene citrate resistant polycystic ovary syndrome(PCOS).Methods:60 cases with clomiphene citrate resistant PCOS were treated with LOD,then they were divided into two groups after operation:treatment group(30 cases treated by bromocriptine after 24 hours),non-treatment group(30 cases without treatment);30 unexplained infertile patients with ovulatory cycle undergoing diagnostic laparoscopy were selected as control group.The changes of ovarian hormones were detected after operation,especially the changes of PRL level,and the follicular development and ovulation situation in treatment group and non-treatment group were compared.Results:There was no significant difference in PRL level before operation and 24 hours and one week after operation between non-treatment group and control group;but the PRL level in the sinus follicular phase of the first menstrual cycle after operation in PCOS group was significantly higher than that in control group(P<0.05).There was no significant difference in PRL level before operation and 24 hours and one week after operation and in the sinus follicular phase of the first menstrual cycle after operation between treatment group and control group(P> 0.05).In non-treatment group,the PRL level in patients with ovulation was significantly lower than that in patients without ovulation;but the follicular diameter in patients with ovulation was significantly larger than that in patients without ovulation(P<0.01).In treatment group,the PRL level in patients with ovulation was significantly lower than that in patients without ovulation;but the follicular diameter in patients with ovulation was significantly larger than that in patients without ovulation(P<0.01).The ovulation rate in treatment group was significantly higher than that in non-treatment group(P<0.05).Conclusion:The PRL level in the sinus follicular phase of the first menstrual cycle after operation in patients with clomiphene citrate resistant PCOS increases,the increase of PRL level is an important cause of follicular dysplasia and no ovulation after operation;the application of bromocriptine within 24 hours after operation is an effective method to prevent and treat follicular dysplasia and no ovulation induced by increase of PRL level,which can be used as a conventional treatment option.更多还原