腹腔镜下处理残留卵巢的不同方法对卵巢功能的影响

The Influence of Different Methods Managing Residual Ovarian Parenchyma in Laparoscopic Surgery on Ovarian Function

目的评价腹腔镜卵巢良性肿瘤剥除术中处理残留卵巢的不同方法对卵巢功能的影响。方法选取因双侧卵巢良性囊肿行腹腔镜下卵巢囊肿剥除术的患者90例,根据处理残留卵巢的不同方法分单极电凝组(A组)、双极电凝组(B组)和缝合组(C组),每组30例。比较各组手术前后的雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)以及窦卵泡计数(AFC)的变化情况。结果全部患者均顺利完成手术,术中未发生任何并发症。3组术后均出现血清E2和AFC降低,FSH和FSH/LH增高,组间比较差异有统计学意义(P<0.05),A、B组与术前比较差异有统计学意义(P<0.05)。A、C组术后分别有8例和1例患者发生卵巢储备功能下降,差异有统计学意义(P<0.05)。结论腹腔镜下卵巢囊肿剥除术中采用单极电凝处理残留卵巢会造成卵巢功能降低,采用双极电凝法会减少对卵巢的损坏,而采用缝合法是保护卵巢功能的最佳方式。

Objective To investigate the influence of different methods managing residual ovarian parenchyma in laparoscopic ovarian benign cystectomy on ovarian function.Methods We reinvestigated the data of 90 patients with both ovarian benign cysts who underwent laparoscopic ovarian cystectomy,the patients were divided into 3 groups according to the methods of managing residual ovarian parenchyma：there were 30 cases with homopolar electrocoagulation（A group）,30 cases with bipolar electrocoagulation（B group）,30 cases with suture（C group）.Postoperative serum estradiol（E2）,follicle stimulating hormone（FSH）,luteinizing hormone（LH）,antral follicle count（AFC） with preoperative index were analyzed in 3 groups.Results All the surgerys were accomplished successfully under laparoscopy and no complication happened.Comparing with preoperation,the postoperative levels of E2 and AFC were decreased,postoperative FSH and FSH/LH were increased in all patients,there were significant differences in A and B group（P〈0.05）.There were significant differences for postoperative level of E2,FSH,FSH/LH,AFC in 3 groups（P〈0.05）.There were 8 cases in A group and 1 cases in C group whose ovarian reserve function had decreased,respectively,the difference was significant（P〈0.05）.Conclusion The homopolar electrocoagulation might decrease ovarian function,the bipolar electrocoagulation could reduce the damage to ovary in laparoscopic ovarian cystectomy.The suture was worth applying and generalizing which was the best method managing residual ovarian parenchyma.