单孔和多孔腹腔镜卵巢囊肿剥除术对卵巢储备功能的影响

Effect of single-port and multi-port laparoscopic ovarian cystectomy on ovarian reserve

目的探讨单孔和多孔腹腔镜卵巢囊肿剥除术对卵巢储备功能的影响。方法选取2014年1月至2015年1月鄂州市妇幼保健院收治的卵巢囊肿患者180例,随机分为单孔腹腔镜手术(SPLS)组100例和多孔腹腔镜手术(MPLS)组80例,记录两组手术时间、出血量、并发症等情况,所有患者于术前、术后1个月和6个月取外周静脉血测定雌二醇(E_2)、促黄体生成素(LH)和促卵泡激素(FSH)水平,比较两组术后卵巢储备功能的变化。结果 SPLS组和MPLS组患者手术时间、术中出血量、血红蛋白下降值和住院时间组间比较差异均无统计学意义(t值分别为0.631、1.325、1.087、0.470,均P>0.05),且囊肿破裂发生率差异无统计学意义(x^2=0.526,P>0.05)。术后1个月,两组患者血清E_2、FSH、LH水平均较术前升高(t值分别为39.803、35.734、43.148、27.184、24.927、20.807,均P<0.05);术后6个月各指标水平均恢复,较术前无明显差异(t值分别为1.602、1.400、0.189、1.500、0.313、0.107,均P>0.05)。结论 SPLS不会对卵巢储备功能有更明显的影响,同时两种术式治疗效果相近,推荐SPLS替代MPLS进行卵巢囊肿剥除术。

Objective To evaluate the effect of single-port and multi-port laparoscopic ovarian cystectomy on ovarian reserve. Methods From January 2014 to January 2015, 180 patients with ovarian cysts admitted in Maternal and Child Health Hospital of Ezhou were randomly divided into single-port laparoscopic surgery （SPLS） group （ n = 100） and multi-port laparoscopic surgery （MPLS） group （ n = 80）. The operation time, blood loss and complications were recorded. Estradiol （ E2 ）, luteinizing hormone （LH） and follicle-stimulating hormone （FSH） levels were measured in all patients preoperatively and I month and 6 months after surgery. The postoperative changes of ovarian reserve were compared between two groups. Results There were no significant differences in operation time, blood loss, hemoglobin decrease value and duration of hospitalization between two groups （ t value was 0. 631, 1. 325, 1. 087 and 0.470, respectively, all P 〉 0.05 ）, and the difference in cyst rupture time was not significant （χ^2 = 0. 526, P 〉 0.05 ）. One month after surgery, E2, FSH and LH levels rose compared with those before surgery （t value was 39. 803, 35. 734, 43. 148, 27. 184, 24. 927 and 20. 807, respectively, all P 〈 0.05 ）. After 6 months, they returned to preoperative levels and were not significandy different from those before surgery （ t value was 1. 602, 1. 400, 0. 189, 1. 500, 0. 313 and 0. 107, respectively, all P 〉 0.05）. Conclusion SPLS does not impact ovarian reserve more significantly. The effect of two procedures is similar, so SPLS is recommended to replace MPLS in ovarian cystectomy.