腹腔镜下卵巢创面两种止血方法对卵巢功能影响的临床研究

Clinical study on the effects of two kinds of hemostasis method of ovarian wound under laparoscope on the ovarian function

目的:观察腹腔镜下卵巢创面两种止血方法所引起的术后卵巢功能改变,探讨镜下卵巢囊肿手术时卵巢功能保护措施。方法:选择卵巢囊肿病例246例,分为两组,一组为双极电凝止血组(Ⅰ组),142例;一组为缝合止血组(Ⅱ组),104例。两组年龄无显著差异。在术后1、3、6个月观察月经改变,检测激素水平,B超监测卵巢动脉血流参数改变、卵巢面积变化、排卵情况。结果:①手术前后两组激素水平变化,术前术后5种激素水平两组差异无统计学意义(P>0.05);术后1个月两组均出现E2水平降低,FSH及LH水平升高(P<0.05);术后3个月两组E2水平均上升,FSH、LH水平下降,与术前相比差异无统计学意义(P>0.05);睾酮(T)、孕酮(P)在术前、术后1个月、术后3个月均无明显变化(P>0.05)。②术后月经情况,出现月经异常的Ⅰ组有27例(占19%),Ⅱ组有17例(占16.3%),两组比较差异无统计学意义(P>0.05)。术后6个月时Ⅰ组月经异常的有10例(7.0%),Ⅱ组有6例(5.8%),两组比较差异无统计学意义(P>0.05);术后6个月与术后3个月相比,差异有统计学意义(P<0.05)。③术后两组排卵情况,术后3个月,在Ⅰ组随访到的56例患者中,监测有排卵者24例(42.9%),Ⅱ组随访到的51例患者中,监测有排卵者17例(33.3%);术后6个月在Ⅰ组随访到的44例患者中,有排卵的31例(70.5%),Ⅱ组随访到的34例患者中,有排卵的28例(82.4%)。因失访率高,无法比较此差异是否具有统计学意义。④手术前后B超监测患侧卵巢基质内动脉血流参数比较显示,Ⅰ组术后3个月及术后6个月患侧卵巢基质内动脉血流参数与术前对侧卵巢基质内动脉血流参数比较差异均无统计学意义(P>0.05);Ⅱ组术后3个月及术后6个月患侧卵巢基质内动脉血流参数与术前对侧卵巢基质内动脉血流参数比较差异亦无统计学意义(P>0.05)。⑤手术前后卵巢截面积变化,术前、术后3个月、6个月两组对侧卵巢截面积差异无统计学意义(P>0.05);术后3个月两组患侧卵巢截面积均小于术前对侧卵巢截面积,电凝止血组为(3.91±2.2)cm2<(4.03±1.02)cm2,缝合止血组为(3.81±1.73)cm2<(3.97±2.02)cm2,但差异无统计学意义(P>0.05);术后6个月两组患侧卵巢截面积均略大于术前对侧卵巢截面积,差异均无统计学意义(P>0.05)。结论:腹腔镜下卵巢囊肿剔除术两种止血方式对围手术期卵巢功能影响不明显。

Objective：To observe the changes of ovarian function after two kinds of hemostasis method of ovarian wound under laparoscope,explore the protective measures of ovarian function during ovarian cysts surgery under laparoscope.Methods：A total of 246 cases with ovarian cysts were selected and divided into bipolar electrocoagulation hemostasis group（group Ⅰ,142 cases） and suture hemostasis group（group Ⅱ,104 cases）.There was no significant difference in the age between the two groups.The menstrual changes were observed and the hormones levels were detected at one,three,and six months after surgery,the changes of ovarian arterial blood flow parameters,the changes of ovarian surfaces,and the ovulation situations were monitored by B ultrasonography.Results：There was no significant difference in five hormones levels before and after surgery between the two groups（P0.05）;at one month after surgery,estradiol levels in the two groups decreased,the levels of follicle stimulating hormone（FSH） and luteining hormone（LH） increased（P0.05）.At three months after surgery,estradiol levels in the two groups increased,the levels of FSH and LH decreased,compared with those before surgery,there was no significant difference（P0.05）.The levels of testosterone and progesterone before surgery,at one and three months after surgery didn＇t change obviously（P0.05）.After surgery,27 cases in group Ⅰ（19%） and 17 cases in group Ⅱ（16.3%） were found with menstrual disorder,there was no significant difference between the two groups（P0.05）.At six months after surgery,10 cases in group Ⅰ（7.0%） and 6 cases in group Ⅱ（5.8%） were found with menstrual disorder,there was no significant difference between the two groups（P0.05）;but there was significant difference between six months after surgery and three months after surgery（P0.05）.At three months after surgery,among 56 cases in group Ⅰ who were followed up,24 cases（42.9%） were found with ovulation;among 51 cases in group Ⅱ who were followed up,17 cases（33.3%） were found with ovulation.At six months after surgery,among 44 cases in group Ⅰ who were followed up,31 cases（70.5%） were found with ovulation;among 34 cases in group Ⅱ who were followed up,28 cases（82.4%） were found with ovulation.Because of the high lost of follow up rate,it was impossible to compare whether the difference was significant.In group Ⅰ,there was no significant difference in the ovarian stromal arterial blood flow parameters between the affected ovaries at three and six months after surgery and the contralateral ovaries before surgery（P0.05）.In group Ⅱ,there was no significant difference in the ovarian stromal arterial blood flow parameters between the affected ovaries at three and six months after surgery and the contralateral ovaries before surgery（P0.05）.There was no significant difference in the ovarian sectional areas before and after surgery（P0.05）;there was no significant difference in the contralateral ovarian sectional areas before surgery and at three,six months after surgery（P0.05）.The affected ovarian sectional areas in group Ⅰ and group Ⅱ at three months after surgery were（3.91±2.2） cm2 and（3.81±1.73） cm2,respectively,which were less than the contralateral ovarian sectional areas before surgery in the two groups（（4.03±1.02） cm2 and（3.97±2.02） cm2,respectively）,but there was no significant difference（P0.05）.The affected ovarian sectional areas in group Ⅰ and group Ⅱ at six months after surgery were slightly larger than the contralateral ovarian sectional areas before surgery in the two groups,there was no significant difference（P0.05）.Conclusion：The effects of two kinds of hemostasis method during oophorocystectomy under laparoscope on the ovarian function during perioperative period are not obvious.