| Objective1.Investigate the effect of laparoscopic ovarian cystectomy on ovarian reserve.2.Investigate the effect of laparoscopic ovarian cystectomy on follicle loss.MethodsIn this study,data were collected from 105 patients who underwent laparoscopic ovarian cystectomy and were diagnosed ovarian cyst in histopathology.According to different histopathological types,it was divided into endometrioma group(42 cases)and non-endometriotic cyst group(63 cases).Analysis was made from two aspects:1.The changes of ovarian reserve after laparoscopic ovarian cystectomy in 105 patients1)Comparison of general clinical data: comparison of age,BMI,fertility,clinical symptoms,cyst diameter,operative time,intraoperativebleeding volume between endometrioma group and non-endometriotic cyst group.2)Comparison of AMH changes after surgery:(1)Comparison of the AMH decline rates between endometrioma group and non-endometriotic cyst group.(2)Comparison of the AMH decline rates between bilateral endometrioma and unilateral endometrioma.(3)Regression analysis of r-ASRM score and AMH decline rate in endometrioma group.2.Analysis of follicle loss during laparoscopic ovarian cystectomy in105 patients1)Comparison of the number of specimens with ovarian cortex,the number of specimens with follicle,thickness of ovarian cortex between endometrioma group and non-endometriotic cyst group.2)Comparison of the number of primordial follicles,primary follicles,secondary follicles and the total number of follicle in the specimen between endometrioma group and non-endometriotic cyst group.3)According to the follicular semi-quantitative score,comparison of the proportion in different levels of ovarian cortex between endometrioma group and non-endometriotic cyst group.Results1.The changes of ovarian reserve after laparoscopic ovarian cystectomy in 105 patients1)There were no significant differences in age,BMI,fertility,and cyst diameter between endometrioma group and non-endometriotic cyst group(P>0.05).There were significant differences in operative time and intraoperative bleeding volume between endometrioma group and non-endometriotic cyst group(P<0.05).In the clinical symptoms,the number of people with dysmenorrhea in the endometrioma group was significantly higher than that in the non-endometriotic cyst group(P<0.05);the number of people with no symptoms in the endometrioma group was significantly lower than that in the non-endometriotic cyst group(P<0.05).2)The mean of AMH decline rate was 33.11% in the endometrioma group,the mean of AMH decline rate was 20.83% in the non-endometriotic cyst group,and there was significant difference between two groups(P<0.05).The mean of AMH decline rate was 42.15% in the bilateral endometrioma group,the mean of AMH decline rate was 28.18%in the unilateral endometrioma group,and there was significant difference between two groups(P<0.05).Regression analysis in the endometrioma group showed a positive correlation between AMH decline rate and r-ASRM score.2.Analysis of follicle loss during laparoscopic ovarian cystectomy in105 patients1)In the endometrioma group,the number of specimens with ovarian cortex was 37,accounting for 88.10%(37/42);the number of specimens with follicle was 28,accounting for 66.67%(28/42);the mean of ovarian cortex thickness was 1.59±1.31 mm.In the non-endometriotic cyst group,the number of specimens with ovarian cortex was 29,accounting for46.03%(29/63);the number of specimens with follicle was 18,accounting for 28.57%(18/63);the mean of ovarian cortex thickness was 0.58±0.88 mm.There were significant differences between two groups(P<0.05).2)In the endometrioma group,the total number of follicles was(12.95±36.79),the number of primordial follicles was(10.83±33.11),the number of primary follicles was(1.76±4.05),and the number of secondary follicles was(0.36±0.93).In the non-endometriotic cyst group,the total number of follicles was(1.37±3.96),the number of primordial follicles was(1.05±3.51),the number of primary follicles was(0.27±0.87),and the number of secondary follicles was(0.05±0.28).There were significant differences between two groups(P<0.05).3)According to the follicular semi-quantitative score: in the endometrioma group,grade 0 had 9 cases,accounting for 24.32%(9/37);grade 1 had 11 cases,accounting for 29.73%(11/37);grade 2 had 9 cases,accounting for 24.32%(9/37);grade 3 had 1 case,accounting for2.70%(1/37);and grade 4 had 7 cases,accounting for 18.92%(7/37).In the non-endometriotic cyst group,grade 0 had 11 cases,accounting for37.93%(11/29);grade 1 had 9 cases,accounting for 31.03%(9/29);grade 2had 7 cases,accounting for 24.14%(7/29);grade 3 had 0 cases,accounting for 0.00%(0/29);and grade 4 had 2 cases,accounting for 6.90%(2/29).There were no significant differences between two groups(P>0.05).Conclusions1.Laparoscopic ovarian cystectomy has a certain effect on ovarian reserve,especially endometrioma surgery.2.For endometrioma,if the disease is bilateral,or has a high r-ASRM score,the effect of the surgery is more serious on ovarian reserve.3.Laparoscopic ovarian cystectomy will result in loss of ovarian tissue and follicles,in which more follicles are lost during endometrioma cystectomy. |
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