多角度评价腹腔镜卵巢良性肿瘤剥除术术后卵巢功能的变化

Evaluation from all aspects on the changes of ovarian function after laparoscopic enucleation of benign ovarian tumor

目的 :多角度评价腹腔镜下行卵巢良性肿瘤剥除术对卵巢功能的影响。方法:收录经B超检查诊断为单侧卵巢良性肿瘤来我院行手术治疗的患者89例,分成2组,其中腹腔镜组46例,开腹组43例。所有患者在术前、术后3个月、术后6个月及术后1年测定雌二醇(E2)、卵泡刺激素(FSH)及黄体生成素(LH)值,随访1年并记录患者月经周期和经量的变化情况;同时进行三维超声检查检测卵巢体积(Vol)、窦状卵泡数(Fo)和卵巢髓质平均血流指数(FI),以判断卵巢储备功能。结果:术后3个月、术后6个月和术后1年E2值、FSH值及LH值两组均与术前水平相当;两组间比较三种激素的差异无统计学意义(P>0.05);术后3个月,无患者月经周期发生显著变化;腹腔镜组3例经量减少(2例于术后4个月恢复,1例于术后6个月恢复),怀孕2例(术后3个月及11个月),开腹组2例经量减少(1例术后4个月恢复,1例术后5个月恢复),术后10个月怀孕1例,两组间比较,差异无统计学意义(P>0.05);三维超声检测结果为:Vol、Fo、FI术前术后两组间比较,差异无统计学意义(P>0.05),每组术后与术前比较,差异无统计学意义(P>0.05),两组均无一例患者肿瘤复发、Vol缩小、卵巢萎缩。结论:腹腔镜手术和开腹术治疗卵巢良性肿瘤,3个月后对卵巢功能无影响;腹腔镜手术不会加重卵巢功能的损害。

Objective： To evaluate from all aspects the influence on the ovarian function after laparoscopic ovarian benign surgery using the bipolar electrocoagulation. Methods： Eighty-nine patients undergone unilateral ovarian benign tumor resection were randomly assigned to two groups, 46 patients in the laparoscopy group and 43 patients in the laparotomy group. The levels of E2, FSH, LH were detected preoperatively and in 3 months, 6 months and lyear after surgery. All the patients were followed up for 1 year and the changes in the menstrual cycle and volume were recorded. To determine the ovarian reserve, ovarian volume （Vol） and antral follicle number （Fo）, ovarian medulla mean flow index （FI） were detected preoperatively and postoperative 3 months, 6 months and 1 year by three dimensional ultrasound. Results： The average levels of the three hormones were no differences between both groups postoperative 3 months, 6 months and lyear. Compared to the preoperative levels, there were no significant differences （P〈0.05） in both groups. After 3 months surgery, there were no significant changes of the menstrual cycles occurred among these patients, but the menstrual volume reduced in 3 cases （including 2 cases recovered in postoperative 4 months and 1 cases recovered in postoperative 6 months） of laparoscopic group, and 2 cases （including 1 case recovered in postoperative 4 months and 1 case recovered in postoperative 5 months） of laparotomy group. There were 2 cases with child in postoperative 3 months and 11 months in laparoscopic group, and 1 case with child in postoperative 10 months in laparotomy group. The average Vol, Fo and FI were similar between two groups, compared to the preoperative results, there were no significant differences in both groups （P〉0.05）, and no case tumor recurrenced, ovarian volume reduced or ovarian shriveled. Conclusion： Laparotomy and laparoscopic surgery both have no impact for ovarian function in 3 months after surgery. Laparoscopic surgery do not aggravate the damage to the ovarian function.