腹腔镜下卵巢子宫内膜异位囊肿剥除术不同止血方法对卵巢储备功能的影响

Influence of various hemostatic methods on ovarian reserve function in women with ovarian endometriotic cyst treated by laparoscopic cystectomy

目的探讨腹腔镜下卵巢子宫内膜异位症（内异症）囊肿剥除术中不同止血方法对卵巢储备功能的影响。方法应用随机数字表法将2007年9月一2008年8月北京大学第一医院妇科和首都医科大学附属北京安贞医院妇产科因双侧卵巢内异症囊肿初次手术的61例患者随机分为两组，术中创面止血采用单纯缝合方法（缝合组）28例，采用电凝止血（电凝组）33例。于术前、术后第2次月经及术后6个月后第1次月经的第2—3天，分别检测患者血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇水平，阴道B超检测窦状卯泡数（F0）、卵巢间质动脉血流的收缩期峰值（PSV），以判断卵巢储备功能。两组患者术前一般状况和卵巢储备功能比较，差异无统计学意义（P〉0．05）。结果缝合组：术前、术后第2次月经及6个月后第1次月经的第2～3天，FSH水平分别为（10．2±2．0）、（11．0±2．2）、（11．5±2．5）U／L，后两者分别与术前比较，差异均有统计学意义（P〈0．05）；雌二醇水平分别为（170±22）、（175±27）、（172±30）pmol／L，分别比较，差异均无统计学意义（P〉0．05）；F。分别为（8．9±2．6）、（7．8±2．1）、（7．6±2．4）个，后两者分别与术前比较，差异也有统计学意义（P〈0．05）；PSV分别为（0．104±0．017）、（0．084±0．016）、（0．086±0．022）m／s，后两者分别与术前比较，差异也均有统计学意义（P〈0．01）。电凝组：术前、术后第2次月经及6个月后第1次月经的第2～3天，雌二醇水平分别为：（166±19）、（196±57）、（205±65）pmol／L，后两者分别与术前比较，差异有统计学意义（P〈0．05）；FSH水平分别为：（10．0±1．5）、（12．2±2．6）、（13．4±4．5）U／L，后两者分别与术前比较，差异也有统计学意义（P〈0．01）；F0分别为（8．9±2．0）、（6．5±2．0）、（6．2±2．5）个，后两者分别与术前比较，差异也均有统计学意义（P〈0．01）；PSV分别为（0．101±0．016）、（0．072±0．021）、（0．067±0．024）m／s，后两者分别与术前比较，差异也均有统计学意义（P〈0．01）。两组术后第2次月经时的F。和PSV、术后6个月后第1次月经的第2～3天时的雌二醇水平、F。、PSV比较，差异均有统计学意义（P〈0．05）。两组术后共发生卵巢储备功能下降12例，缝合组4例，电凝组8例。结论腹腔镜下双侧卵巢内异症囊肿剥除术后可能造成卵巢储备功能下降，对卵巢创面出血的处理，电凝法较单纯缝合法所致卵巢储备功能下降更加明显。

Objective To investigate the influence on ovarian reserve function in treatment of ovarian endometriotic cyst by laparoscopic eystectomy with various hemostasis management. Methods From September 2007 to August 2008, 61 patients with bilateral ovarian endometriotic cyst in Peking University First Hospital and Anzhen Hospital Affiliated to Capital University of Medicine were treated by [aparoscopic cystectomy. Those patients were divided into two groups randomly, which were 28 patients in suture group and 33 patients in electro coagulation during the operation. Blood samples were obtained from the patients before the operation, on the day 2 or 3 of the second menstrual cycle after operation and the first menstrual cycle after 6 months operation. The serum levels of follicle stimulating hormone（FSH） , luteinizing hormone （LH）, estradiol（E2） were tested. At the same time, total antral follicles （ F0 ） and mean ovarian stromal peak systolic blood flow velocity （PSV） were detected by transvaginal ultrasonography to evaluate ovarian reserve function. Results There was no significant difference in paitents＇ clinical characteristics and ovarian reserve function between two groups （P 〉 0. 05 ）. In the suture group, the serum level of FSH were （ 10. 2 ± 2. 0） U/L before operation, （ 11.0 ± 2.2） U/L on day 2 or 3 of the second menstrual cycle and （11.5 ± 2. 5 ） U/L on day 2 or 3 of the first menstrual cycle after 6 months＇ operation respectively. In comparison of data before operation, it exhibited significant difference（ P 〈 0. 05 ） ; F0 were 8. 9 ± 2. 6 before operation, 7.8± 2. 1 on day 2 or 3 of the second menstrual cycle and 7.6 ± 2.4 on day 2 or 3 of the first menstrual cycle after 6 months＇operation. When compared with data before operation, it showed significant difference（P 〈0. 05） ;PSV were （0. 104±0. 017）m/s before operation, （0. 084 20. 016） m/s on day 2 or 3 of the second menstrual cycle, （0. 086 ± 0. 022） m/s on day 2 or 3 of the first menstrual cycle after 6 months＇ operation, it also showed significant difference between preoperation and postoperation（ P 〈 0. 01 ）. In the electro coagulation group, the serum level of E2 were （ 166 ± 19） , （ 196 ±57） , （205 ±65） pmol/L, serum level of FSHwere （10.0±1.5）,（12.2±2.6）,（13.4±4.5） U/L, F0wereS.9±2.0, 6.5±2.0, 6.2±2.5（P〈0.01）;PSV were （0.101 ±0.016）,（0.072 ±0.021）,（0.067 ±0.024） m/s before operation and on day 2 or 3 of the second menstrual cycle after operation and the first menstrual cycle after 6 months operation. They all showed significant difference between preoperation and postoperation. In the second menstrual cycle post operation （ on day 2 or 3 ）, the data of F0 and PSV were statistically different between the two groups（P 〈 0. 05） ; in the first menstrual cycle 6 months after the operation （on day 2 or 3 ）, The serum level of E2, F0 and PSV were statistically different between the two groups （ P 〈 0. 05 ） . Conclusion It suggested that ovarian reserve function would be decreased in treatment of bilateral ovarian endometriotic cyst by laparoscopic cystectomy, it was more serious when electro coagulation hemostasis were given.