卵巢肿物剥除术不同止血方式对卵巢功能的影响

The influence of different hemostatic methods on the ovarian function

目的探讨卵巢肿物剥除术中使用可吸收线缝合、单、双极电凝及超声刀四种方式止血对卵巢功能的影响。方法共200例单侧卵巢良性肿瘤患者均行卵巢肿物剥除术,按不同止血方式分为超声刀组、单极电凝组、双极电凝组、可吸收线缝合组每组50例,分别于术前、术后1个月、术后3个月及术后6个月的月经周期第2~3天化验卵泡刺激素（FSH）、促黄体生成素（LH）、雌二醇（E2）,并行阴道彩超监测卵巢窦卵泡数（AFC）,同时随访术后6个月期间的月经变化。结果四组患者术前性激素、窦卵泡数及月经改变比较差异无统计学意义（P〉0.05）。术后1个月较术前均出现E2下降和FSH、LH增高及窦卵泡数减少,与术前比较差异均有统计学意义（P〈0.05）;术后3个月可吸收线缝合组激素水平基本恢复术前水平,其余三组较术前比较差异均有统计学意义（P〈0.05）,超声刀组E2水平偏高,FSH、LH水平偏低,与其余两组比较差异有统计学意义（P〈0.05）,可吸收线缝合组及超声刀组窦卵泡数恢复正常范围;术后6个月超声刀组激素水平基本恢复,但单极组、双极组E2、FSH、LH较术前比较差异仍有统计学意义（P〈0.05）,但较之术后1个月比较,E2有所升高,FSH、LH有所降低,差异有统计学意义（P〈0.05）。窦卵泡数较术前比较差异均无统计学意义（P〉0.05）。月经的改变主要表现为月经周期延长、月经量减少,偶有经期延长及轻微潮热出汗,情绪烦躁的表现,但在术后3~6个月间症状基本消失,并没有出现闭经及严重围绝经期症状的患者。结论卵巢肿物剥除术中可吸收线缝合对卵巢功能影响最小而恢复最快的。超声刀组较高频电刀组（单极、双极）恢复快,影响小。

Objective To compare the the influence of different hemostatic methods on ovarian function in ovarian cystectomy.Methods Two hundred women who underwent ovarian cystectomy were divided randomly into four groups of 50 cases in each：the ultrasonic scalpel group,the monopolar coagulation group,the bipolar coagulation group and the absorbable suture group.Venous blood samples at the second day of menstrual cycle and the amounts of follicles were detected before and 1,3 and 6 months postoperation.All cases were followed up to obtain the menstrual condition.Results The ovarian function of all cases was significantly decreased 1 month postoperation compared to preoperation.The concentrations of the steroid hormone in the absorbable suture group were firstly restored at the 3th month after surgery.At 6 months after surgery,the ovarian function of the absorbable suture group and ultrasonic scalpel group returned to the baseline.However,the levels of FSH and LH were still higher than the basal condition in the monopolar coagulation group and bipolar coagulation group.In all groups,compared to the basal condition,there were no difference of follicle amounts and menstrual cycle at the 6th month after surgery.Conclusion Compare to the hemostasis by ultrasonic scalpel,monopolar coagulation and bipolar coagulation,absorbable suturation in ovarian cystectomy had the advantages of less injury of ovarian function and faster postoperative recovery.