腹腔镜卵巢囊肿剥除术不同止血方式对卵巢功能的近期影响研究

Short-term Influences of Different Hemostatic Methods during Laparoscopic Ovarian Surgery on Ovarian Function

目的探讨腹腔镜下卵巢囊肿剥除术不同止血方式对卵巢功能的近期影响。方法 115例拟行卵巢囊肿剥除术的单侧卵巢良性肿瘤患者,随机分为4组:开腹对照组30例、超声刀组26例、单极电凝组31例、镜下缝合组28例。分别于术前、术后1个月、术后3个月检测血性激素水平。结果术前,4组患者雌二醇(E2)、卵泡刺激素(FSH)、促黄体生成激素(LH)、孕酮(P)、睾酮(T)水平比较,差异均无统计学意义(P>0.05)。术后1个月,4组患者E2、FSH、LH水平比较,差异均有统计学意义(P<0.05),P、T水平比较,差异均无统计学意义(P>0.05);其中开腹对照组较其他3组E2水平明显升高,FSH、LH水平明显降低,差异均有统计学意义(P<0.05)。术后3个月,4组患者E2、FSH、LH水平比较差异均有统计学意义(P<0.05),P、T水平比较差异均无统计学意义(P>0.05);其中单极电凝组较其他3组E2水平明显降低,FSH、LH水平明显升高,差异均有统计学意义(P<0.05)。单极电凝组月经异常6例,超声刀组月经异常3例,开腹对照组和镜下缝合组无明显月经异常改变。结论开腹术和腹腔镜手术均对卵巢功能有一定影响,但腹腔镜手术使用单极电凝会加重卵巢近期功能的损害,使用镜下缝合或超声刀可更好地保留其功能。

Objective To study the short - term influences of different hemostasia methods during laparoscopic ovarian surgery on the ovarian function. Methods Totally 115 patients with unilateral ovarian cyst who were going to receive laparoscop- ic ovarian surgery were randomly divided into four surgical groups： the laparotomy group （ n = 30）, ultrasound scalpel group （ n= 26）, unipolar electrocoagulation group （ n = 31 ）, and arthroscopic suture group （ n = 28 ）. The sexual hormones levels were determined before surgery and one month and three months after surgery. Results Before surgery, the differences in the levels of E2, FSH, LH, P, T of the four groups were not significant （P 〉0. 05）. One month after surgery, the levels of E2, FSH,and LH were significantly different among these four groups （ P 〈 0. 05 ）, while no significant difference was found in the levels of P and T （P 〉 0. 05）. Compared with the other three groups, the laparotomy control group had significantly increased E2 level, while the levels of FSH and LH significantly decreased （P 〈 0. 05）. Three months after surgery, the levels of E2, FSH, andLH were significantly different among these four groups （P 〈 0. 05 ）, whereas the levels of P and T showed no significant differ- ences （ P 〉 0. 05 ） ; compared with the other three groups, the level of E2 in unipolar electrecoagulation group significantly de- creased greatly whereas the levels of FSH and LH significantly increased （ P 〈 0. 05 ）. Six patients in the unipolar electrocoagula-tion group and 3 patients in the ultrasound scalpel group had abnormal menstruation, which was not found in laparotomy group and arthroscopic suture group. Conclusion Both open and laparoscopic surgery have certain impact on ovarian function. How- ever, the application of uniopolar electrocoagulation during the laparoscopie surgery can aggravate the damage of the ovarian func-tion. Arthroscopic suture or ultrasonic scalpel can better preserve the ovarian function.