腹腔镜下卵巢囊肿剥除术后创面电凝和缝合止血对残留卵巢储备功能的影响

The influence on ovarian reservation function of electric coagulation and saturation managing residual ovarian parenchyma in laparoscopic oophorocystectomy

目的探讨腹腔镜下不同解剖位置卵巢囊肿剥除术后残留卵巢创面采用双极电凝和缝合止血方法对卵巢储备功能的影响。方法 2008年1月至2011年6月在川北医学院附属医院妇产科收治的双侧卵巢囊肿患者120例。随机分为电凝组(60例)和缝合组(60例)。比较两组不同解剖位置卵巢囊肿剥除术后的雌二醇(E2)、卵泡刺激素(FSH)、黄体生成激素(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;两组中位于卵巢门以外卵巢囊肿,术后雌二醇(E2)、FSH以及AFC比较差异无统计学意义(P>0.05);两组位于卵巢门附近的卵巢囊肿,电凝术后E2和AFC均显著下降,FSH显著升高,差异均有统计学意义(P<0.05);缝合术后的E2、FSH以及AFC差异无统计学意义(P>0.05);位于卵巢门附近的卵巢囊肿剥除术后采用电凝止血组术后卵巢功能衰竭病例发生5例,而采用缝合组没有卵巢功能衰竭发生。结论为保护残留卵巢功能,腹腔镜下卵巢囊肿剥离后的创面出血采用何种止血方式与囊肿的解剖位置有关。对于囊肿位于卵巢门部位外的,双极电凝简便易行,对残留卵巢功能影响小;而对于囊肿位于卵巢门部位的,应尽量采用缝合止血的方法,并注意缝合的深度。

Objective To study the influence on ovarian reservation function of bipolar electric coagulation and suture hemostasis managing residual ovarian parenehyma in laparoscopic oophoroeystectomy. Methods 120 patients with both ovarian cysts were treated in department of obstetrics and gynecology of the Affiliated Hospital of Sichuan North Medical College between January 2008 and June 2011. The patients were divided randomly into bipolar electric coagulation group （60cases） and suture group （ 60 cases）. Postoperative serum estradiol （ E2 ） , follicle stimulating hormone （ FSH ） , luteini- zing hormone（ LH）, antral follicle count（AFC） with preoperative index were analyzed in two groups. Results All surgery were accomplished successfully under laparoseopy and no complication happened. For ovarian cysts lied in outside of hi- lum of ovary, postoperative levels of E2 and FSH and AFC were no difference （ P 〉 0. 05 ）. For ovarian cysts lied in vicini- ty of hilum of ovay, the postoperative levels of E2 and AFC of bipolar electric coagulation group decreased, postoperative FSH increased in all patients, there were significant differences in two groups （ P 〈 0. 05 ）, but the postoperative levels of E2 and AFC and FSH of suture group were no diflernce（P 〉0. 05） ; bipolar electric coagulation group had 5 cases of o- varian reserve function failure, but suture group had not cases of ovarian reserve function failure. Conclusion In order to protect residual ovarian function in laparoscopie oophorocystectomy, the chosen hemostatie method is related to anatomical position of ovarian cyst. If ovarian cyst locates in outside of hilum of ovary, bipolar electric coagulation is more convenient and less influence to ovarian reservation function. If ovarian cyst locates vicinity of hilum of ovary, suture method is less influence to ovarian reservation function. Suture method is recommended, but pay attention to suture depth.