腹腔镜下卵巢巧克力囊肿剥除术中不同止血法对卵巢储备功能的影响

Effects of different hemostasises during laparoscopic enucleation of ovarian chocolate cyst on ovarian reserve function

目的:探讨腹腔镜下卵巢子宫内膜异位囊肿剔除术中不同的创面止血方法对术后卵巢储备功能的影响。方法:将首都医科大学附属北京安贞医院妇产科2008年8月～2009年8月因双侧卵巢巧克力囊肿初次手术患者50例随机分为两组,术中分别采用不同的创面止血方法,缝合组25例,电凝组25例。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天分别抽血检测卵泡刺激素(bFSH)、黄体生成素(bLH)、雌二醇(bE2)及阴道B超检测窦状卵泡数(Fo)、卵巢间质动脉血流的收缩期峰值(PSV)以判断卵巢储备功能。结果:①两组患者术前一般状况和卵巢储备功能比较无统计学差异。②缝合组手术后两个时段的bFSH、Fo、LH与术前相比差异有统计学意义(P<0.05),PSV相比差异亦有统计学意义(P<0.01);电凝组术前与术后两个时段的bE2、bFSH、Fo、PSV相比差异均有统计学意义(P<0.05)。③电凝组与缝合组比较,术后第2次月经Fo、PSV和术后6个月后第1次月经E2、Fo差异有统计学意义(P<0.05),电凝组E2水平升高,而Fo水平下降。结论:腹腔镜双侧卵巢子宫内膜异位囊肿剥除术后可能发生卵巢储备功能下降,采用电凝的方法处理卵巢创面出血者,较采用单纯缝合的方法处理创面出血者卵巢储备功能下降趋势更加明显,故医生应该采用合理的治疗方式,尽量保护卵巢的储备功能。

Objective：To explore the effects of different hemostasises for wound surface during laparoscopic enucleation of ovarian chocolate cyst on ovarian reserve function.Methods：50 cases who received operation for the first time because of bilateral ovarian chocolate cysts in department of gynecology and obstetrics in Beijing Anzhen Hospital Affiliated to Capital Medical University from August 2008 to August 2009 were divided into two groups randomly： suture group（25 cases） and electric coagulation group（25 cases）,then the cases in the two groups were treated with different hemostasises.Blood samples were obtained before operation,during the second menstruation after operation,on the second and third days during the first menstruation and at 6 months after operation to detect the levels of blood follicle stimulating hormone（bFSH）,blood luteinizing hormone（bLH） and blood estradiol;transvaginal B ultrasound was used to detect the number of antral follicles and PSV of ovarian interstitial artery to estimate ovarian reserve function.Results：①There was no significant difference in general conditions before operation and ovarian reserve function between the two groups.②There was significant difference in the levels of bFSH and LH,the number of antral follicles before two time periods after operation and before operation（P0.05）,there was significant difference in PSV between the two groups（P0.01）.In electric coagulation group,there was significant difference in the levels of blood estradiol and bFSH,the number of antral follicles and PSV before operation and at two time periods after operation（P0.05）.③There was significant difference in the number of antral follicles and PSV during the second menstruation after operation and estradiol level and the number of antral follicles during the first menstruation at 6 months after operation between suture group and electric coagulation group（P0.05）;in electric coagulation group,the level of estradiol increased and the number of antral follicles decreased.Conclusion：Bilateral laparoscopic enucleation of ovarian chocolate cyst may cause decrease of ovarian reserve function,compared with treating wound surface with suture method,the patients adopting electric coagulation to treat wound surface have obviously decreasing trend,thus,the doctors should choose reasonable therapy to protect ovarian reserve function to the greatest extent.