腹腔镜卵巢囊肿剥除术中采用不同止血方法对卵巢功能的影响

Influence of different hemostasis methods on ovarian function in laparoscopic ovarian cyst removal surgery

目的 探讨腹腔镜卵巢囊肿剥除术中采用超声刀、单极电凝止血以及镜下缝合止血对卵巢功能的影响。方法 选取2012年7月-2013年12月在本院进行腹腔镜治疗的85例卵巢囊肿患者作为研究对象,根据不同的止血方法分为超声刀组（n=24）、电凝组（n=31）和缝合组（n=30）。比较3组手术前后的月经改变情况、激素水平变化、类围绝经期综合征情况。结果 缝合组和超声刀组术后3、6个月的月经异常改变率、类围绝经期综合征发生率显著低于电凝组,差异有统计学意义（P〈0.05）。电凝组术后3、6个月的E2水平显著低于术前,FSH、LH水平显著高于术前,差异有统计学意义（P〈0.01）。电凝组术后3、6个月的E2水平显著低于超声刀组和缝合组,FSH、LH水平显著高于超声刀组和缝合组,差异有统计学意义（P〈0.01）。结论 腹腔镜卵巢囊肿剥除术中采用单极电凝止血对卵巢功能影响较大,超声刀组和缝合组影响小,并且超声刀操作更为方便,值得临床推广应用。

Objective To explore the influence of ultrasonic scalpel,monopolar electrocoagulation and microscopic suture for hemostasis on ovarian function in laparoscopic ovarian cyst removal surgery. Methods 85 cases with ovarian cyst treated by laparoscopy from July 2012 to December 2013 in our hospital were selected and divided into the ultrasonic scalpel group（n=24）,electrocoagulation group（n=31） and the microscopic suture group（n=30） according to different hemostasis methods.The change of menstruation,hormone level and the condition of peri menopausal syndrome among three groups before and after surgery was compared. Results The abnormal change rate of menstruation and the incidence rate of syndrome of peri menopausal syndrome at the third and sixth months after surgery in the microscopic suture group and in the ultrasonic scalpel group was lower than that in the electric coagulation group,with significant difference（P〈0.05）.The level of E2 at the third and sixth months after surgery in the electrocoagulation group was lower than that after surgery,the level of FSH,LH at the third and sixth months after surgery in the electrocoagulation group was higher than that after surgery,with significant difference（P〈0.01）.The level of E2 at the third and sixth months after surgery in the electrocoagulation group was lower than that in the ultrasonic scalpel group and in the microscopic suture group,the level of FSH,LH at the third and sixth months after surgery in the electrocoagulation group was higher than that in the ultrasonic scalpel group and in the microscopic suture group,with significant difference（P〈0.01）. Conclusion The influence of monopolar electrocoagulation for hemostasis on ovarian function in laparoscopic ovarian cyst removal surgery is relatively large,the influence of ultrasonic scalpel and microscopic suture for hemostasis is relatively small,and the operation of ultrasonic knife is more convenient,it is worthy of clinical promotion and application.