腹腔镜下卵巢子宫内膜异位囊肿剥除术止血方法对卵巢储备功能的影响

Influence of different hemostatic methods on ovarian function during laparoscopic ovarian endometriosis cystectomy

目的探讨腹腔镜卵巢子宫内膜异位囊肿剥除术中不同止血方法对卵巢储备功能的影响。方法选取解放军总医院第七医学中心因卵巢子宫内膜异位囊肿行腹腔镜下囊肿剥除术的60例患者。随机分成两组:使用缝合止血方法的为缝合组(30例),使用双极电凝止血方法的为电凝组(30例)。比较两组不同时段的雌二醇(E2)、黄体生成素(LH)、卵泡刺激素(FSH)、抗苗勒管激素(AMH)变化情况。结果(1)电凝组AMH数值术后3 d和1、3、6个月分别为(1.6±1.2)、(1.7±1.3)、(2.9±1.6)、(3.1±1.4)ng/ml,均低于缝合组[分别为(2.5±1.6)、(2.5±1.5)、(3.7±1.1)、(4.0±1.3)ng/ml],差异有统计学意义(P<0.05)。电凝组、缝合组术后3 d、1个月AMH值较同组术前下降,差异均有统计学意义(P电凝组<0.01,P缝合组<0.05)。缝合组术后6个月AMH值与同组术前相比上升,差异有统计学意义(P<0.05)。(2)电凝组和缝合组术后3 d、术后1个月与同组术前FSH值相比较,FSH水平均升高,差异有统计学意义(P<0.01)。(3)电凝组和缝合组术后3 d LH值较同组术前均有上升,差异有统计学意义(P<0.01)。结论缝合法止血比电凝法止血更有利于卵巢储备功能的保护;AMH比FSH能更好地评价卵巢储备功能。

Objective To investigate the effect of different hemostatic methods on ovarian reserve function during laparoscopic ovarian endometriosis cystectomy.Methods Sixty patients who underwent laparoscopic cystectomy for ovarian endometriosis in the Seventh Medical Center of Chinese PLA General Hospital were selected.They were randomly divided into two groups:the suture group(30 cases)in which the suture method was used and the electrocoagulation group(30 cases)in which the bipolar electrocoagulation method was adopted.The changes of levels of estradiol(E2),luteinizing hormone(LH),follicle-stimulating hormone(FSH),and anti-mullerian hormone(AMH)in the two groups at different time points were compared.Results(1)The AMH values of the electrocoagulation group at each time point after operation were lower than those of the suture group,and the difference was statistically significant[three days after operation,one month after operation,three months after operation,and six months after operation,(1.6±1.2)ng/ml vs(2.5±1.6)ng/ml,(1.7±1.3)ng/ml vs(2.5±1.5)ng/ml,(2.9±1.6)ng/ml vs(3.7±1.1)ng/ml,(3.1±1.4)ng/ml vs(4.0±1.3)ng/ml respectively,P values were 0.017,0.031,0.028,0.012 respectively].In both groups,the AMH values were lower at three days and one month after operation,and the difference was also statistically significant.The AMH values in the suture group increased at six months after operation,and the difference was statistically significant(P<0.05).(2)Compared with preoperative FSH values in both groups at three days and one month after operation,the FSH level increased,and the difference was statistically significant(P<0.01).(3)The postoperative 3 d LH values in both groups increased,and the difference was statistically significant(P<0.01).Conclusions Suture hemostasis is more conducive to the protection of ovarian reserve function than electrocoagulation hemostasis.AMH is a better indicator of ovarian reserve function than FSH.