腹腔镜卵巢囊肿剔除术中应用不同止血方法对卵巢功能的影响

Effects of Different Hemostatic Methods in Laparoscopic Ovarian Cyst Resection on Ovarian Functions

目的探讨在行腹腔镜卵巢囊肿剔除术中应用不同的止血方法对卵巢功能的影响。方法选取2010年6月~2013年6月行腹腔镜卵巢囊肿剔除术90例,根据医生意愿分为双极电凝组、单极电凝组以及缝合组各30例,比较3组术后1、6个月卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）。结果 1 3组均随访满1年,单极电凝组月经紊乱发生率为33.3%（10/30）,明显高于双极电凝组[10.0%（3/30）,χ2=4.812,P=0.028]及缝合组[6.7%（2/30）,χ2=6.667,P=0.010],双极电凝组与缝合组比较则无统计学差异（χ2=0.000,P=1.000）。2 3组术前、术后1个月FSH、LH、E2差异均无统计学意义（P〉0.05）;术后6个月,双极电凝组FSH、LH、E2与缝合组比较差异均无统计学意义（P〉0.05）,单极电凝组FSH[（10.43±2.04）U/L]及LH[（18.58±3.82）U/L]水平明显高于双极电凝组[（8.12±1.82）U/L,（13.31±2.53）U/L]（P〈0.05）和缝合组[（7.08±1.68）U/L,（12.61±2.68）U/L]（P〈0.05）,而E2[（252.5±26.9）pmol/L]明显低于双极电凝组[（321.3±28.2）pmol/L]（P〈0.05）和缝合组[（313.7±31.4）pmol/L]（P〈0.05）。结论在腹腔镜卵巢囊肿剔除术中应用双极电凝止血相对单极电凝止血安全,值得临床推广应用。

Objective To investigate the effects of different hemostatic methods in laparoscopic ovarian cystectomy on ovary functions.Methods A total of 90 cases of laparoscopic ovarian cyst resection from June 2010 to June 2013 were selected.They were divided into bipolar electrocoagulation group,monopolar electrocoagulation group,and suture group according to the doctor＇s favor.The FSH,LH,and E2 before and after surgery were compared among the three groups.Results All patients were followed up for more than 1 year.The rate of patients with menstrual disorder in monopolar electrocoagulation group [33.3%（10 /30） ] was significantly higher than that in bipolar coagulation group [10.0%（3 /30）,χ2= 4.812,P = 0.028]and suture group [6.7%（2 /30）,χ2= 6.667,P = 0.010].There was no significant difference between bipolar premature coagulation group and suture group（χ2=0.000,P = 1.000）.There was no significant difference in FSH,LH,and E2 among the three groups before and 1 month after surgery（P 0.05）.There was no significant difference in FSH,LH,E2 between bipolar premature coagulation group and suture group 6months after surgery（P 0.05）.In the monopolar electrocoagulation group,the FSH [（10.43 ± 2.04） U / L] and LH [（18.58 ±3.82） U / L] levels were significantly higher than those in the bipolar electrocoagulation group [（8.12 ± 1.82） U / L and（13.31 ±2.53） U / L,P 0.05],and in the suture group [（7.08 ± 1.68） U / L and（12.61 ± 2.68） U / L,P 0.05].The E2 level in the monopolar electrocoagulation group [（252.5 ± 26.9） pmol / L] was significantly lower than that in the bipolar electrocoagulation group[（321.3 ± 28.2） pmol/L,P 0.05]and in the suture group [（313.7 ± 31.4） pmol/L,P 0.05].Conclusion In laparoscopic ovarian cystectomy,bipolar coagulation hemostasis is safer than monopolar electrocoagulation hemostasis,being worthy of clinical application.