Effects Of GnRH-a Combined With Laparoscopic Surgery On Ovarian Endometriotic Cyst On Ovarian Reserve Function And Pain Score

Objective:To investigate the effect of GnRH-a combined with laparoscopic conservative surgery for the treatment of ovarian endometriotic cyst on ovarian reserve function and pain score,and to guide treatment of ovarian endometriotic cyst.Methods:Collect the date from November 2016 to July 2018 which after laparoscopic conservative surgery and postoperative pathological diagnosis of ovarian endometriotic cyst(OEMC)patients in the first affiliated hospital of Nanchang university,age range from 20 to 39,clinical data of the patients were improved before and 6 months after surgery,including patient age,age of menarche,parity,days of the menstrual cycle,intraoperative conditions such as cyst and diameter,postoperative pathology,postoperative medications,data of outpatient review included serum basal follicle-stimulating hormone(bFSH),basal luteinizing hormone(bLH),basal estradiol(bE2),anti-mullerian hormone(AMH)and Visual Analogue scale(VAS)score before and 6 months after surgery,etc.,r-AFS staging was performed intraoperatively according to the EM staging method modified by the American society of fertility in 1997.The follow-up date was up to January 2019.Visual analogue pain score(VAS)was used for pain assessment of dysmenorrhea,pelvic pain,and coital pain,with a score of 0-10,0 for painless and 10 for severe pain.According to the postoperative application of gonadotropin-releasing hormone agonists(GnRH-a),the patients were divided into two groups:group A(surgery group)only performed laparoscopic conservative surgery,and no drugs were used postoperatively(42 cases).Group B(surgery combined with drugs)was treated with GnRH-a for 3 months after laparoscopic conservative surgery(45 cases).Serum bFSH,bFSH/bLH,bE2,AMH and VAS scores were compared between the two groups before and 6 months after surgery.According to the postoperative bFSH level of 87 patients,they were divided into group C(bFSH≥10 IU/L)and group D(bFSH<10 IU/L),and the relevant clinical data of patients in group C and D were compared.SPSS24.0 software was used for data analysis,counting data was analyzed by X~2 test,measurement data was expressed by±s,and analyzed by t test.P<0.05was considered statistically significant.Results:1.The age,age of menarche,number of pregnancy,menstrual cycle,r-AFS stage,cyst side and cyst diameter of patients in group A and group B were compared,and the differences were not statistically significant(P>0.05).2.The VAS scores of the two groups before and 6 months after surgery were compared as follows:there was no significant difference in preoperative VAS score between the two groups(P>0.05).There was no significant difference in VAS score between group B(surgery combined drugs group)and group A(surgery group)6months after surgery(P>0.05),but the score of group B 6 months after surgery was lower than that of group A.VAS scores of both groups 6 months after surgery were lower than those before surgery(P<0.05).3.The postoperative sex hormone levels and AMH values of the two groups were compared as follows:there was no significant difference in preoperative bFSH,bFSH/bLH,bE2 and AMH between the two groups(P>0.05).Postoperative serum bFSH,bFSH/bLH,bE2 and AMH were significantly different(P<0.05).In addition,the postoperative serum bFSH,bFSH/bLH,bE2 and AMH values of the two groups were significantly different from those before surgery(all P<0.05).4.No GnRH-a was used in group C after surgery.The average age of patients in group C was significantly higher than that in group D,and the differences in r-AFS stage and the composition ratio of unilateral and bilateral cysts between the two groups were statistically significant(all P<0.05).There was no significant difference in age of menarche,preoperative bFSH,number of pregnancy and menstrual cycle between the two groups(P>0.05).Conclusion:1.Both laparoscopic conservative surgery combined with GnRH-a for the treatment of ovarian endometrial cyst and laparoscopic surgery alone can reduce the patients’VAS score.2.Ovarian reserve function decreased in OEMC patients after laparoscopic conservative surgery,and improved after GnRH-a treatment.3.Age,r-AFS stage,unilateral or bilateral cysts,and whether GnRH-a is used after surgery are the influencing factors of ovarian reserve function in OEMC patients after laparoscopic conservative surgery.