腹腔镜手术治疗卵巢囊肿及对卵巢功能的影响

Laparoscopic surgery treatment of ovarian cysts and its impact on ovarian function

目的总结腹腔镜手术治疗卵巢囊肿的效果并探讨其对卵巢功能的影响。方法收集采用腹腔镜手术治疗的60例卵巢囊肿患者的临床资料，总结分析腹腔镜手术治疗卵巢囊肿的疗效与优点，并分别于术前及术后3个月-1年内月经周期第3天测定血雌二醇（E2）、孕酮（P）、促卵泡激素（FSH）及黄体生成素（LH），比较激素水平的变化，评价手术对卵巢功能的影响。结果所有患者均在腹腔镜下完成手术，手术时间（50．5±14．7）min，术中出血量（49．8±18．7）ml。术后肛门排气时间18～28h，平均24h。术后无手术切口感染、出血、皮下气肿、尿潴留及脏器损伤，无中转开腹，术后超声监测卵巢大小均在正常范围内，均痊愈出院。术后7—60d内月经来潮。术后3个月时随访，患者无月经异常改变，无卵巢囊肿复发。术后E2[（39．84±5．64）vs（40．9±5．83）pmol／L，P〉0．05]和P[（2．01±0．85）vs（2．30±0．63）nmol／L，P〉0．05]水平与术前比较，差异无统计学意义；术后FSH[（11．9±2．4）vs（7．0±I．8）U／L，P〈0．05]和LH[（10．8±2．1）vs（6．0±2．5）U／L，P〈0．05]水平明显高于术前。结论腹腔镜手术治疗卵巢囊肿具有创伤小、痛苦轻、出血少、腹腔干扰少、住院时间短、机体康复快以及对输卵管、卵巢的功能损伤小等优点，值得临床推广应用，但腹腔镜手术对卵巢功能的远期影响还有待于进一步观察。

Objective To summarize and analyze the outcome and experience of laparoscopic surgery treatment of ovarian cysts and explore its impact on ovarian function. Methods A total of 60 patients with ovarian cysts who received laparoscopic surgery treatment were included in this analysis. The therapeutic effect and its merit were discussed, and levels of estradiol （ E2 ）, progesterone （ P）, follicle-stimulating hormone （FSH） and luteinizing hormone （LH） were detected before operation and at the third day of menstrual phase within 3 months to 1 year after operation. Changes of hormone levels were compared,and the impacts of operation on ovarian function were assessed. Results Laparoscopic procedures were successfully done in all patients. Procedure duration time was （50. 5 ± 14. 7） rain;the volume of blood loss during operation was （49. 8 ± 18. 7）ml;pestoperative anal exhaust time was 18-28 （average 24） hours. There were no adverse events including postoperative incision infection, bleeding, subcutaneous emphysema, urinary retention and organ damage. There was no transit laparotomy. Postoperative ultrasound monitoring of ovarian size was all within normal range. All patients were uneventfully discharged. The menstrual onset was within 7-60 days after operation. In follow-up of 3 months,there were no changes of menstrual abnormality and recurrence of ovarian cysts. Comparing with pre-operation, the levels of E2 [ （ 39.84 ± 5.64） vs （40. 95 ±5.83） pmol/L,P〉0.05]and P[（2.01 ±0.85） vs （2.30 ±0.63） nmol/L,P 〉0. 05]were all not significantly different while the levels of FSH[（11.9±2.4） vs （7.0±1.8） U/L,P〈0. 05]andLH[（10. 8±2.1） vs （6.0 ±2.5） U/L,P〈 0. 05 ] were higher after operation. Conclusions Laparoscopie operation of ovarian cysts has advantages of less trauma,less bleeding, less abdominal interference, quicker body recovery, less functional damage of fallopian tube and ovarian, therefore it should be promoted. Because limits of time and numbers of cases, the impacts of laparoscopic surgery treatment of ovarian cysts on ovarian function should be further observed.