腹腔镜子宫内膜异位囊肿剔除术两种止血方法对年轻患者卵巢储备功能的影响

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

目的探讨腹腔镜下卵巢子宫内膜异位囊肿剔除术两种止血方法对年轻患者卵巢储备功能的影响。方法将2007年1月至2010年1月在余姚市人民医院因单侧卵巢子宫内膜异位囊肿且年龄≤35岁的住院患者84例随机分为两组,缝合止血组(A组)37例和电凝止血组(B组)47例。两组患者术前、术后首次月经及6个月后的第一次月经周期第3天检测基础性激素水平、窦卵泡计数(antral follicle count,F0)、卵巢间质血流峰值(peak systolic blood flow velocity,PSV)、卵巢体积,术前、术后不同时点组内及两组组间比较上述指标。结果在性激素方面,与术前比较,A组患者不同时点血清雌二醇(estradiol,E2)、促卵泡激素(follicle stimulating hormone,FSH)、促黄体生成素(luteinizing hormone,LH)水平、FSH/LH比值差异无统计学意义(P>0.05);B组患者在首次月经周期第3天各指标差异无统计学意义(P>0.05),术后6个月E2、FSH、FSH/LH比值差异有统计学意义(P<0.05)。两组间比较,术后不同时点B组较A组FSH水平升高,差异有统计学意义(P<0.05),E2水平、FSH/LH比值在首次月经周期第3天差异无统计学意义(P>0.05),术后6个月FSH/LH比值差异有统计学意义(P<0.05)。在阴道超声方面,两组患者术后不同时点与术前自身比较,F0、PSV、卵巢体积均下降,差异均有统计学意义(P<0.05)。组间比较,B组各指标下降高于A组,差异有统计学意义(P<0.05)。结论腹腔镜下卵巢子宫内膜异位囊肿剔除术两种止血方法对卵巢储备功能均有影响,尤以电凝止血法对卵巢功能的影响更为显著。

Objective To investigate tile influence on ovarian reserve for treatment of ovarian endometriotic cyst lay laparoscopic cysteetomy with two hemostatic methods in young women. Methods From Jan. 2007 to Jan. 2010, 84 patients less than 35 year- old with single lateral ovarian endometriotic cyst in Yuyao People＇s Hospital, Zhejiang Province were divided into two groups randomly that 37 patients were in hemostatie suture group （A group） and 47 patients were in electric coagulation group （ B group） during the operation. The basal sex hormone levels, amounts of basal antral follicles, peak systolic blood flow velocity（PSV） and basal ovarian volume were tested before the operation and on the third day in the first menstrual cycle after operation and the first menstrual cycle after 6 months operation. Clinic data were compared by selfcontrol study and Contrastive Study. Results Compared with the data before operation, sex hormone including estradiol （ E2 ） , follicle stimulating hormone （ FSH ）, luteinizing hormone（LH） levels, FSH/LH ratio of A group at different time points after operation had no statistical significance （ P 〉 0. 05 ）, but the data of B group at 6th month after operation were varied and had statistically significant （ P 〈 0. 05 ）. The FSH values of B group was higher than that of the A group at different time points and the difference was statistically significant（ P 〈 0. 05 ）. The differences of E2 levels, FSH/LH ratio at the 6th month after operation were statistically significant between two groups （ P 〈 0. 05 ） while the differences of which on the 3^rd day were no statistically significant （P 〉0. 05 ）. The data of basal antral follicles, PSV, basal ovarian volume by transvaginal sonography of B group were declined more than than of A group at different time points after operation compared with those before operation that the difference was statistically significant（ P 〈0. 05 ）. The data of B group were declined more than A group, the difference was statistically significant （P 〈 0. 05 ） between two groups. Conclusion Both of the two bemostatic methods in laparoscopic cystectomy for ovarian endometriotic cyst have effects on ovarian reserve, especially electro- coagulation hemostasis has more.