腹腔镜卵巢囊肿剥除术中止血方法的选择对卵巢功能的影响

A study of the influence on the ovarian function using different hemostasia methods after laparoscopic ovarian surgery

目的探讨腹腔镜卵巢囊肿剥除术中使用不同止血方法对卵巢功能的影响。方法选择120例单侧卵巢良性肿瘤患者行腹腔镜卵巢囊肿剥除术，并分为4组：超声刀组、单极电凝组、双极电凝组、缝合组，每组30例。于术前、术后3个月和6个月抽血检测E2、FSH、LH，并术后随访。结果单，双极电凝组术后发生月经改变及围绝经期综合征明显多于超声刀组和缝合组（P〈0．05）。四组术后3个月和6个月较术前均出现E2下降和FSH、LH增高，其中单、双极电凝组分别与术前比较差异有统计学意义（P〈0．05）。此两组分别与超声刀组和缝合组术后E2、FSH、LH的比较差异有统计学意义（P〈0．05）。双极电凝组术后3个月的E2较单极电凝组明显偏高（P〈0．05），该两组的E2术后6个月较术后3个月显著增高（P〈0．05）。结论腹腔镜下卵巢囊肿剥除创面采用电凝止血会引起卵巢功能的损害，而使用镜下缝合或超声刀止血可更好地保留其功能。

Objective To study the influence on the ovarian function using different hemostasia methods after shelled out the ovarian cyst by laparoscope. Methods 120 patients with unilateral ovarian benign cyst underwent laparoscope were assigned to 4 groups： ultrasonic scalpel group, monopolar electrocoagulation group, bipolar electrocoagulation group and suture group. Every group had 30 cases. The levels of E2, FSH, LH were detected respectively before the operations and at 3 months,6 months after the operations. All patients followed up for 6 months. Results the monopolar group and bipolar group had more menstruation abnormality and perim- enopausal syndrome than the other two groups（P〈0.05）. The levels of E2 declined and those of FSH and LH increased in all groups at 3 months and 6 months after the operations compared with those before operations. Moreover, there was significant difference compared with levels before operations in the monopolar group and bipolar group respectively（P〈0.05）. The postoperative hormone levels of the monopolar group and bipolar group also respectively had significant difference compared with those of the ultrasonic group or suture group （P〈0.05）. At 3 months after the operations, the levels of E2 in the bipolar group were significantly higher than those in the monopolar group （P〈0.05）. The postoperative levels of E2 in the monopolar group and bipolar group were significantly higher at 6 months than at 3 months（P〈0.05）. Conclusion Using the monopolar and bipo- lar electrocoagulation to stanch when stripped of the overian cyst by laparoscope can lead to the damage of the ovarian function. The suture or using ultrasonic scalpel is a good protective measure.