The Influence Of Loop Electrosurgical Excision Procedure On Ovarian Reserve Function In Patients With Cervical Intraepithelial Neoplasia

Objective:To explore the influence of LEEP on the ovarian reserve function of patients with CIN,and guide the clinical treatment of patients with cervical lesions,especially in young patients with fertility requirements.Methods:Collect 852 cases patients who were underwent LEEP in the gynecological clinic of Wangnan Medical College affiliated yijishan hospital,the patients were from October 2013 to October 2015.Filter the research object according to the following 7 standards:?1?20-38 years old women of childbearing age;?2?no ovarian surgery;?3?no uterine surgery;?4?normal menstrual cycle;?5?normal menstrual volume;?6?no endocrine diseases and systemic diseases history;?7?voluntary participation this study.According to the above criteria a total of 63 cases were selected to study object,including 12 cases of CINI,26 cases of CIN II,25 cases of CIN III.All of the subjects in the morning of the third day period in 1 month before surgery for ovarian reserve function test: 1.Basic sex hormone and gonadotropin determination: FSH,LH,E₂;2.Transvaginal ultrasonography: antral follicle count?AFC?,ovarian volume?OV?,ovarian artery peak systolic velocity?PSV?,pulsation index?PI?,resistance index?RI?.Then in 3-7 days after menstruation clean this month underwent LEEP by colposcopy,the same ovarian reserve function examinations were made on same time of the third menstrual day in the first month,the third month,and the sixth month after surgery.Use statistical methods to compare whether the detection indicators reacting the reserve function of ovarian have changed between LEEP preoperative and postoperative,Whether the difference is statistically significant.Results:1.Basic sex hormone and gonadotropin level: The overall level of basic E₂ before and after LEEP presented downward trend,the measured results of 4 times were:?58.79±10.86?pg/ml,?54.73±10.78?pg/ml,?57.82±8.70?pg/ml,?54.35±10.97?pg/ml.The results of the first and sixth month after LEEP compared with the preoperative P<0.05,the difference was statistically significant.The overall level of basic FSH and LH were increasing,the measured results of 4 times were as follows:?8.27±1.84?m IU/ml,?9.01±1.71?m IU/ml,?8.35±1.54?m IU/ml,?9.10±2.40?m IU/ml;?6.15±1.99?m IU/ml,?6.96±2.42?m IU/ml,?6.69±2.21?m IU/ml,?7.11±2.30?m IU/ml.The results of the first and sixth month after LEEP compared with the preoperative P<0.05,the difference was statistically significant.2.Flow conditions: PSV value decreased after LEEP,the measured results of 4 times were:?19.14±3.85?cm/s,?17.80±3.35?cm/s,?18.36±3.28?cm/s,?17.78±3.45?cm/s.The results of the first and sixth month after LEEP compared with the preoperative P<0.05,the difference was statistically significant.RI value generally showed an increasing trend,the measured results of 4 times were: 0.48±0.10,0.51±0.10,0.50±0.09,0.52±0.12.The results of the first and sixth month after LEEP compared with the preoperative P<0.05,the difference was statistically significant.3.Antral follicle count and ovarian volume: The value of AFC decreased after the LEEP operation,the measured results of 4 times were: 7.71 ±2.70,7.63 ±2.30,7.43 ±2.28,6.79 ±2.24.The results of the sixth month after LEEP compared with the preoperative P<0.05,the difference was statistically significant.The value of OV presented downward trend,the measured results of 4 times were:?5.67±1.70?cm³,?5.57±2.50?cm³,?5.34±1.91?cm³,?5.06±1.78?cm³.The results of the sixth month after LEEP compared with the preoperative P<0.05,the difference was statistically significant.Conclusions:1.LEEP may reduce the level of E₂ in patients and elevate the level of FSH and LH;decrease blood flow velocity and pulsation index,increase resistance index;can reduce the volume of ovary,the number of antral follicle.2.LEEP was mainly through endocrine effects of ovarian blood supply,reproductive system and direct heat injury caused by conduction to the decline of ovarian reserve.3.LEEP may reduce the ovarian function and ovarian reserve function,accelerate the decline process,so we should strictly control the indications for surgery,especially the young nulliparous patients should avoid surgery.