腹腔镜卵巢囊肿剥除术中序贯式止血法对卵巢功能的影响

The study of laparoscopic ovarian cystectomy in sequential hemostasis affect ovarian function

目的：探讨腹腔镜卵巢囊肿剥除术中序贯式止血法对患者卵巢功能的影响。方法76例单双侧卵巢囊肿切除患者，按照就诊顺序分为观察组和对照组。观察组38例，术中采用序贯式止血法对出血创面进行处理；对照组38例，术中采用双极电凝法对出血创面进行止血处理。比较两组手术时间，并分别在术后1、4个月对患者血清激素水平进行监测，比较两组手术前后血清雌二醇（ E2）、黄体生成素（ LH）及卵泡刺激素（FSH）水平。结果观察组手术时间为（58．0±8．1）min，对照组为（61．0±5．4）min，差异无统计学意义（t＝1．32，P＞0．05）；观察组术前血清 E2值为（131．4±9．6） poml/L、LH 为（5．8±1．7） IU/L、FSH 为（7．8±1.9）IU/L，而对照组分别为（128．3±10．1）poml/L、（5．8±2．2）IU/L、（6．0±1．3）IU/L，两组差异均无统计学意义（t＝1．34、0．82、1．02，均P＞0．05）；术后1个月两组E2、FSH水平较术前均下降（观察组t＝4．31、4．10，对照组t＝4．18、4．15，均P＜0．05）；术后4个月对照组E2水平高于观察组（t＝5．22，P＜0．05），LH、FSH水平明显低于观察组（t＝4．20、5．09，均P＜0．05）。结论腹腔镜卵巢囊肿剥除术中序贯式止血法能有效维持性激素水平，保护卵巢生理功能正常，为有效的止血方式，值得进一步临床推广。

Objective To explore the laparoscopic ovarian cystectomy in sequential hemostasis for female patients with ovarian function .Methods 76 cases of patients with unilateral or bilateral ovarian cyst of our hospital from September 2011 to September 2012 were selected ,who were divided into the observation group and control group in accordance with the order of treatment .The observation group was 38 patients,intraoperative hemostasis were used sequential processing on bleeding wounds;The control group was 38 patients,intraoperative were used bipolar electro-coagulation treatment on bleeding wound to stop bleeding .Two groups were given the same preoperative nursing inter-vention,the two groups were observed and compared preoperative serum estradiol , luteinizing hormone and follicle-stimulating hormone and other hormone levels .Operative time were compared,respectively,1,4 months after surgery for hormone levels monitored.Results The mean operative time was （58.0 ±8.1） min in the observation group,（61.0 ±5.4）min in the control group,the two groups showed no significant difference （t =1.32,P〉0.05）;the observation group were preoperative serum estrogen diol （E2）values（131.4 ±9.6）poml/L,luteinizing hormone（LH） was （5.8 ±1.7）IU/L,follicle-stimulating hormone（FSH）（7.8 ±1.9）IU/L,were E2 preoperative value（128.3 ± 10.1）poml/L,LH value（5.8 ±2.2） IU/L,FSH（6.0 ±1.3） IU/L,the two groups showed no significant difference （t=1.34,0.82,1.02,all P〉0.05）;groups of patients after one month E2,FSH levels were decreased compared with the preoperative,with significant difference（the observation group,t=4.31,4.10,the control group t=4.18,4.15,all P〈0.05）;4 months after E2 levels were lower than that of the control group （t=5.22,P〈0.05）,LF,FSH levels were significantly higher than the observation group （t=4.20,5.09,all P〈0.05）.Conclusion Laparoscopic ovarian cystectomy in sequential method can effectively maintain hemostatic levels of sex hormones, the normal physiological function of ovarian protection for the effective way to stop bleeding ,which is worthy of further clinical practice .