| Objective:To investigate the changes of serum anti-Mullerian hormone after laparoscopic benign ovarian tumor excision,and to evaluate the effect of laparoscopic benign ovarian tumor excision on ovarian reserve capacity by measuring the level of AMH.The benefit or damage of ovarian reserve capacity after laparoscopic treatment was evaluated by AMH measurement.The factors such as different age,pathological type,tumor size,single and bilateral tumor were analyzed,and then the effects of different factors on ovarian reserve capacity were found.so as to provide effective research data for the evaluation of ovarian reserve function after benign ovarian tumor excision.Method:In this study,74 patients with pathologically diagnosed benign ovarian tumors were randomly selected from August 2019 to August 2020 in Da Lian Obstetrics and Gynecology Hospital of Da Lian Medical University,and their clinical data were prospectively analyzed.The patients were divided into groups according to age,tumor size,unilateral and bilateral tumor,different pathological types and other factors,and the changes of serum AMH levels before and after operation were analyzed between groups and within groups.Enzyme linked immunosorbent assay(Elisa)was used to determine the level of AMH before and after operation.The data were analyzed by SPSS 26.0 software.The measurement data were tested by Dagstino test for normality,the indexes with normal distribution were expressed by mean ±standard deviation(SD),the indexes with non-normal distribution were expressed by median and quartile distance,and the indexes with non-normal distribution were expressed by Mann-Whitney U test.The counting data were expressed as percentage(%),and Chi-square test or Fisher exact probability method was used for comparison between groups.Spearman correlation analysis was used to analyze the correlation,p < 0.05.There was statistical significance.Results:(1)The level of AMH in benign ovarian tumors before operation was negatively correlated with age,the correlation coefficient was R =-0.335,and the correlation coefficient test was p < 0.05.The preoperative AMH level in endometriosis cyst group was 18-25 years old > 26-35 years old > 36-45 years old.The AMH levels were 2.69ng/ml,2.26(1.23-3.96)ng/ml,0.93(0.44-2.75)ng/ml,18-25 years old group,respectively.The AMH level increased to 3.72 ng / ml after the first menstruation after operation,and there was no significant difference compared with that before operation(p > 0.05).The levels of AMH in 26-35 years old group and 36-45 years old group after the first menstruation decreased to 1.72(1.08-3.26)ng/ml and 0.72(0.21-2.17)ng/ml,respectively,compared with those before operation,there was no significant difference(p > 0.05).The preoperative AMH level in non-endometriotic cyst group was 18-25 years old group > 26-35 years old group > 36-45 years old group.The level of AMH was 2.62(1.85-3.24),2.20(1.59-2.99),1.38(1.02-2.64)ng/ml,respectively.Six months after operation,the level of AMH in 18-25 years old group increased to2.72(1.88-3.46)ng/ml,compared with that before operation.There was no significant difference(p > 0.05)in AMH levels between 26-35 years old group and 36-45 years old group.There was no significant difference between 26-35 years old group and36-45 years old group(p > 0.05).There was no significant difference between 26-35 years old group and 36-45 years old group.(2)In endometriotic cysts,the levels of AMH in ≤ 6cm group and > 6cm group were2.96(1.08-3.98)ng/ml and 1.81(0.57-2.49)ng/ml,respectively.After the first menstruation,the level of AMH in ≤ 6cm group and > 6cm group decreased to2.35(0.97-3.47),1.24(0.39-1.94)ng/ml,≤ 6cm group and > 6cm group respectively,the difference was statistically significant(p < 0.05).In non-endometriotic cysts,the levels of AMH in ≤ 6cm group and > 6cm group were 2.44(1.20-2.33)ng/ml and 1.98(1.57-2.68)ng/ml,respectively.6 months after operation,the level of AMH in ≤ 6cm group increased to 3.31(1.89-3.89)ng/ml,compared with that before operation,the difference was statistically significant(p< 0.05).The level of AMH in 6cm group decreased to 1.86(1.38-2.68)ng/ml,and there was no significant difference compared with that before operation(p > 0.05).(3)In endometriosis cysts,the preoperative AMH levels of unilateral group and bilateral group were 2.45(0.81-3.44),2.02(0.86-3.76)ng/ml,respectively,after the first menstruation,the AMH levels decreased to 1.90(0.64-2.98)ng/ml and 1.39(0.53-2.97)ng/ml,respectively,and there was no significant difference between the two groups(p > 0.05).In non-endometriotic cysts,the preoperative AMH levels in unilateral group and bilateral group were 2.09(1.58-3.01)and 2.68(1.43-2.77)ng/ml,respectively.Six months after operation,the level of AMH in unilateral group increased to2.21(1.52-3.62)ng/ml,compared with that before operation,but the level of AMH in bilateral group decreased to 1.91(1.38-3.19)mm.Compared with that before operation,the difference was not statistically significant(p > 0.05).(4)In 17.1% of patients with endometriotic cysts,the level of AMH after the first menstruation after operation was higher than that before operation.According to the modified staging method of endometriosis by the American Association of Reproductive Medicine(ASRM),the preoperative AMH level in ≤ 40 group and > 40 group AMH were 2.42(1.21-4.03),2.25(0.55-3.18),after the first menstruation,the level of AMH in the group ≤ 40 increased to 2.88(1.08-3.72)ng/ml,and there was no significant difference compared with that before operation(p > 0.05).The level of AMH in > 40 group decreased to 1.36(0.39-2.26)ng/ml,and there was no significant difference compared with that before operation(p > 0.05).There was significant difference between ≤ 40 group and > 40 group after the first menstruation(p < 0.05).Conclusions:1.In patients with non-endometriotic cysts,the ovarian reserve function rapid recovery after laparoscopic ovarian cystectomy in patients with tumor size ≤ 6cm,but there was no significant effect on ovarian reserve function after laparoscopic ovarian cystectomy in patients with tumor size > 6cm,different ages and patients with unilateral or bilateral tumors.2.In patients with endometriotic cyst,the ovarian reserve capacity decreased significantly after the first menstruation in patients with ASRM score > 40 and tumor size > 6cm. |
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