The diagnosis and treatment of the syndrome of the Polycystic ovary
The syndrome of the Polycystic ovary is in 1935 reported a way first by the Stein and the Leventhal, past again call Stein-Leventhal comprehensive advertise for.It is to grow outbreak polypeptide because of sex, clinical situation polymorphism of comprehensive advertise for.Although the early years has scholar to define this symptoms as menostasis, sterility and has another hair and fattness, and has been follow to use up to now, recent years’ knowing its clinical feature further be furtherthat the androgen is excessive and chronic anovulation(chronicanovulation), therefore, its treatment principle should to this carry on.The syndrome of the Polycystic ovary is one species female endocrine out of tune sex disease, its outbreak reason is very complicated, cardinal performance for after getting married sterility, menostasis, have another the hair, fattness, double side ovary the envelope, peplos increase thick, the ovary augmentation present have another capsule change, have no ovulation more, good the hair grow the female of the period at the green middle age.Mainly include the following several specieses for the clinical situation of familiar ovary syndrome of a Polycystic of the reason of female infertility:
1, oligomenorrhea with the result that menostasis:This patient’s great majority is after hair menostasis, while just starting menstruate menstrual cycle normal, the menstrual cycle will prolong gradually hereafter, with the result that menostasis, through quantity how much uncertain, separately the performance of the sufferer in order to have no ovulation the metrorrhagia of the sexual function, 2, sterility:The sterility causes for ovulating a disturbance, disorder of original hair sterility or after hair sterility.3, fattness:Invite half sufferers contains this performance.4, have another a hair:The familiar hair increase, thick and black, present a male type distribution, if have a beard.The mammary ridge turnover contains black hair, the hairs increase, and parts of sufferers have an acne.5, double the side ovary enlarge:Pass B super or the perioneoscope can discover a pair of sides ovaries augmentation, the envelope, peplos increase thick, inside ovary it is thus clear that arrive the ovarian follicle of most sterigma, have no dominant follicle creation.
The above symptom syndrome of not each Polycystic ovary sufferer expresses all symptoms, but greatly parts of sufferer expresses proptosis one part of symptoms, the sufferer, who have, is just the B super check to discover an ovary augmentation while seek medical advice infertility and present have another capsule change but diagnosis is the syndrome of the Polycystic ovary.The endocrine change of the syndrome of the Polycystic ovary sufferer usually according to sufferer different clinical situation but dissimilarity, the put of endocrine hormone doesn’t need a fixed amount measurement, androgenic’s increase is the basic feature of the syndrome of the Polycystic ovary, , will appear the hypophysis, pituitary gland Cu ovarian follicle born hormone and the Cu luteinizing hormone LH/FSH a specific value to go up in the meantime, parts of patient’s companions have an estrin, estrogen the light degree to increase Gao and hyperinsulinism.
Diagnose the syndrome of the Polycystic ovary can’t be pure to depend on clinical situation to confirm, he has to carry on a put of endocrine hormone to don’t need a metered side to settle, if sufferer’s performance includes menostasis, fattness and has another a hair, sterility, and has LH/FSH a specific value variety, the androgenic go up, the B is super or the perioneoscope check discover a pair of sides ovaries augmentation, the envelope, peplos increase thick, then can diagnose for the syndrome of the Polycystic ovary.The syndrome of the Polycystic ovary sufferer’s passing by to treat mostly can acquire good treatment effect but pregnancy, it the pregnancy rate of comprehensive treatment can reach to 70% or so.We at clinical up once met this an infertility sufferer, after getting married 13 years, sterility, the beginning menstruation, mensis rule, hereafter menstruation, mensis rarely seen, how many months come once, again afterwards come right away need not medicine menstruation, mensis with the medicine menstruation, mensis not, at that time say with the patient’s words, eat of the medicine hate can’t pull with the shelf car, effect everywhere beg to cure to also have no effect, finally they that has a patient who cures at my sterility center to his introduction, she takes to try and see of the mood arrives at my center to cure and pass completely check to confirm for the syndrome of the Polycystic ovary, according to his condition, I am to him take a treats a distance for five days of medicine, at that time he greatly is angry, she says us to go to other places to see a doctor is all big pack peridiole, peridiolum of medicine still don’t so see, connect run so many trip just see the condition clear, effect to make so the medicine of 1.30 dollars money, can cure illness?You don’t also see the Za common people have no money and do I take more than 1,000 dollars this time.I speak for him, I comprehend your mood in nowadays, can the doctor see a doctor according to you of the condition need to use a medicine, according to your condition in nowadays you need to use so some medicines, the disease cures to cure so not and very no longer in use how much medicine but lie in using a pharmacopoeia to the disease would effectively, if you took these medicines invalid you seek me again.Effect he is every month after take the medicine 50 days are through the anaphase, menstruation, mensis end, arrive my sterility center to seek medical advice again, saw me say:The director of the Yuan:My menstruation, mensis(?) originally all wrong month, ate you now of the medicine should don’t come still not, can I when think ° to be good a disease?According to her disease, I am to her checked 1 Yun early and early, effect masculine gender, I say for her:Your Si through pregnancy, she anyway also doesn’t believe, at Yun three months I check B to her super, I say for her:You see, you of is the kid dancing in you of the uterus, until she just dares to believe from the glasses of Si at this time and afterwards born a white and fat now of size trochanter F through much more 4 years old.Pass this case, I want give infertility the sufferer say so a few words and diagnose not clear, use a medicine ineffective, whether can you of the disease cure like, its key isn’t lie in use how much medicine, but lie in using a pharmacopoeia to the disease will be effectively.Parts of syndrome of the Polycystic ovary sufferer to the drug treat sensitive not, the drug curative effect isn’t good, can carry on a surgical operation treatment, the surgical operation treat behind the menstruation, mensis(?) recover the normal probability as 90%, pregnancy rate is 70%, its curative effect is very optimistic. 1, generally the one who treat fattness strengthen hardiness and limit high sugar, high sterone Diet with remission body weight, because of sterone and pile up excessive will turn worse the degree of high insulin and high androgen, is also cause have no ovulation of one of the important factors.The body weight descends a 10 Kgs and can reduce insulin level 40%, the decrease testosterone level is 3.5%, and probably the instauration ovulate.
2, the drug treat
(1)anti- androgen
1, oral contraception:The period therapy is in brief a species the demulcent therapy, reconciliation opposite more safe method.The oral contraception makes the androgen concentration that ovary and adrenal gland, suprarenal gland produce lower.The estrin, estrogen composition makes the sex hormone binding globulin, SHBG concentration increase in the contraceptive, anticonceptive and visit to leave testosterone decrease as a result;The progestogen composition passes the creation androgen of depression, inhibition LH but decrease ovary.Use a medicine 6 ? 12 periods can repress a hair growth and treat an acne, about 2/3 sufferers be effective.
2, the acetic acid progesterone inside the annulus:(cyproterone acetate, CPA)In order to synthesize 17 ? Qian progesterone derivatives, have a stronger nti- androgen an action, compete a recipient with testosterone and dihydrotestosterone, and induce the liver enzyme acceleration blood plasma the metabolism Kuo of the androgen pure, lower the living creature effect of androgen thus.Much use to reach English ? currently 35(diane-35), the slice contains a female ketolase(EE)35 ugs of the CPA2 mgses, Gui each time, make period therapy, namely in hemorrhage from the 5th dayses, take orally 1 slice everyday, continuous the 21th, stop a medicine 7 again use a medicine in the days to come, total 3 the ?s be 6 months.Can resist the androgen excessive symptom, and can adjust a menstrual cycle.
3, ester(spironolactone) inside the Luo:BE 17 ester Zi compounds inside the ? Luos of artificial petpide synthetase, the recent years discover in addition to diureses action, it still has depression, inhibition ovary and adrenal gland, suprarenal gland biosynthesis androgen, and compete an androgen recipient in the hair follicle.The anti- androgen dose is 50 ?s 200 mgs/d and treat to have another a hair to need to use a medicine 6 the ?s be 9 months.The one who appear menstruation, mensis anomaly can unite an application with oral contraception.
4, the gonadotropin release the hormone excited elixir(GnRHa):With the big dose depression, inhibition method make the gonadotropin reduce, reduce ovary petpide synthetase a hormone thus.Can use flexure Pu Rui a wood(triptoreline) a 3.75 mgs, period the iliacus notes the 2nd day, every the 28th once, total 6 months.
5, sugar corticosteroid:Be applicable to the PCO wants a S androgen excessive is adrenal gland, suprarenal gland source or the mixing source.In common usely fill a rice to loosen a 0.25 mgs/d, in order to prevent excessiveness depression, inhibition the hypophysis, pituitary gland ? adrenal gland, suprarenal gland axial action.
(2)induced ovulation:Detailed see this section 1.Because the PCOS sufferer’s induced ovulation more and easily erupt an ovary to excessively stimulate comprehensive advertise for, have to strengthen prevention measure:1, HMG ? the HCG isn’t a PCOS sufferer the head of the Cu ovulation choose a project.2, several ovarian follicles attain maturation phase or ovary true conjugate diameter, anteroposterior diameter>6 cms, shouldn’t add to use HCG.
3, the surgical operation treat
(1)perioneoscope surgical operation:Be applicable to serious PCOS to treat an invalid to the Cu ovulation drug.Beat a pore, porus towards having another a capsule ovary with electricity Ning or laser technique puncture under the perioneoscope, the ovary of the side beats a pore, porus 4 each time for proper.
(2)wedge resection of ovary:Department abdomen made sure diagnosis first when department abdomen fish for, then double the side ovary cuneus form cut off 1/3 tissues, since low androgen level, remiss a hirsutism form thus, exaltation pregnancy rate.In the Shu applied microsurgical technique in order to prevent post-operative glue to connect, can acquire 90% ovulation rate and 70% pregnancy rates.
