腹腔镜卵巢囊肿剥除术使用超声刀、单极电凝对卵巢功能的影响

A study of the influence on the ovarian function using the ultrasonic scalpel and the monopolar electrocoagulation after laparoscopic ovarian surgery

目的探讨腹腔镜卵巢囊肿剥除术中使用超声刀、单极电凝对卵巢功能的影响。方法选择90例单侧卵巢良性肿瘤患者,均行腹腔镜卵巢囊肿剥除术,按不同的止血方法,将其分为3组:超声刀组30例、单极电凝组30例、镜下缝合组30例作为对照组。分别于术前、术后3个月、术后6个月抽血检测E2、FSH、LH,并术后随访。结果单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镜下缝合组(P<0.05)。3组病例术后3个月和术后6个月较术前均出现E2下降和FSH、LH增高,其中单极电凝组与术前比较差异有统计意义(P<0.05)。并分别与超声刀组和镜下缝合组术后E2、FSH、LH的比较差异有统计学意义(P<0.05)。单极电凝组的E2术后6个月较术后3个月增高,也差异有统计学意义(P<0.05)。结论腹腔镜下卵巢囊肿剥除创面采用单极电凝止血会引起对卵巢功能的损害,而使用镜下缝合或超声刀止血可更好的保留其功能。

Objective To study the influence on the ovarian function using the ultrasonic scalpel and the monopolar electrocoagulation respectively after shelled out the ovarian cyst by laparoscope. Methods 90 patients with unilateral ovarian benign cyst underwent laparoscope were assigned to three groups by different he- mostasia methods including ultrasonic scalpel, monopolar electrocoagulation and suture as the controlled group. Every group had 30 cases. The levels of E2, FSH, LH were detected respectively before the operations and at 3m ,6m after the operations. All patients followed up for 6m. Results the monopolar group had more menstru- ation abnormality and perimenopausal 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 3m and 6m after the operations compared with those before operations. Moreover, there was significant difference compared with levels before operations in the monopolar group （ P 〈 0.05 ）. The postoperative hormone levels of the monopolar group also had significant difference re- spectively compared with those of the ultrasonic group and suture group （ P 〈 0. 05 ）. The postoperative levels of E2 in the monopolar group were significantly higher at 6m than at 3m（ P 〈 0. 05 ）. Conclusion Using the monopolar 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.