腹腔镜卵巢囊肿剔除术中不同止血方式的临床观察

Clinical observation on different hemostatic methods in laparoscopic ovarian surgery

目的探讨腹腔镜卵巢囊肿剔除术中采用不同的止血方式对患者卵巢功能的近期影响。方法收集2008年8月至2010年12月在我院行腹腔镜卵巢囊肿剔除术的病例94例,按照术中止血方式分为缝合组和电凝组,其中单侧缝合组16例,双侧缝合组20例,单侧电凝组38例,双侧电凝组20例。观察2组手术时间、术中出血量。术后3个月检测卵泡刺激素(FSH),黄体生成素(LH)和雌二醇(E2),随访月经情况。结果缝合组与电凝组比较手术时间长、术中出血量增多,差异有统计学意义。术后3个月随访双侧电凝组FSH升高,E2降低,与术前比较有差异(P<0.05),发生2例闭经,其余3组激素水平较术前无明显变化,均在术后45天内月经恢复。结论腹腔镜下卵巢囊肿剔除术采用电凝止血与缝合止血比较,手术时间短,出血量少,但双侧卵巢囊肿剔除术采用电凝止血对卵巢功能有一定程度的影响,对有生育要求的患者应注意围手术期卵巢功能的评估和卵巢的保护。

Objective To evaluate the short-term influences of different hemostatic methods during laparoscopic ovarian surgery on the ovarian function. Methods Totally 94 patients with benign ovary cyst underwent laparoscopicsurgery from August 2008 to December 2010 in our hospital . The patients were randomly divided into 2 groups according to hemostatic methods during the operation：suture groups and electriccoagulation groups. Including 16 cases of unilateral suture group, bilateral suture group 20 cases, unilateral electrocoagulation group of 38 patients, bilateral electrocoagulation group of 20 patients. Operative time, blood loss was observed. Serum levels of FSH, LH, and E2 was detected 3 months after the operation, follow-up of menstruation. Results Comparing surgical suture group and coagulation group for a operative time, increased blood loss, the difference was statistically significant （ P 〈 0. 01 ）. The levels of E2 declined and those of FSH increased in the bilateral electrocoagulation group at 3 month period after the operations compared with those before the operation （ P 〈 O. 05 ）, the remaining three groups have no significant changes in the hormone levels. There are two cases of amenorrhea ilateral in electrocoagulation group and remaining cases restore menstrual within 45 days. Conclusions Electric coagulation during laparoscopic ovarian has the advantages of shorter operative time, less blood loss. Both ovaries coagulation have a certain influence on ovarian function, we should pay more attention to the assessment of ovarian function and protection for the patients of childbearing requirements.