腹腔镜下卵巢囊肿剥除术不同止血方式对残留卵巢功能的影响

Effect of different methods of hemostasis on residual ovarian function in laparoscopic ovarian cystectomy

目的:探讨腹腔镜下卵巢囊肿剥除术中采用不同止血方式对残留卵巢功能的影响。方法:选取择期行腹腔镜下卵巢囊肿剥离术的单侧卵巢良性肿瘤患者76例作为研究对象,随机将患者分为两组,镜下缝合止血作为缝合组(38例),电凝止血作为电凝组(38例),记录两组术后出血量及卵巢功能下降率;观察两组术前、术后1个月及术后6个月卵泡刺激素(follicle stimulating hormone,FSH)、抑制素B(inhibin B,INHB)、抗苗勒管激素(anti-Mullerian hormone,AMH)水平;行阴道超声检查,记录窦卵泡数(antral follicle count,AFC)、卵巢间质动脉血收缩期峰值流速(peak systolic flow velocity,PSV)的变化。结果:术后1个月、6个月,两组FSH、INHB、AMH、AFC、PSV差异有统计学意义(P<0.05);缝合组卵巢功能下降率(0 vs.10.53%)较电凝组低,差异有统计学意义(P<0.05)。结论:镜下缝合是腹腔镜卵巢囊肿剥离术中较理想的止血方式,对卵巢组织、血管损伤较小,术后6个月血清性激素水平、AFC、PSV可趋于正常,减少了对残余卵巢功能的影响。

Objective：To investigate the effect of different methods of hemostasis on residual ovarian function in laparoscopic ovarian cystectomy.Methods：Seventy-six patients with unilateral ovarian benign tumor who admitted into the hospital for elective laparoscopic ovarian cystectomy were selected as the research objects.The patients were randomly divided into two groups.Patients who received laparoscopic hemostatic suture were selected as the suture group（ n = 38） and who received electric coagulation hemostasis were selected as the electric coagulation group（ n = 38）.The postoperative bleeding volume and the decline rate of ovarian function of the two groups were observed.The levels of follicle stimulating hormone（ FSH）,inhibin B（ INHB） and anti-Mullerian hormone（ AMH） in the two groups were observed before operation and in 1 month,6 months after operation.The transvaginal ultrasound examination was performed and the changes of antral follicle count（ AFC） and ovarian stromal artery peak systolic flow velocity（ PSV） were recorded.Results：There were statistically significant differences in FSH,INHB,AMH,AFC and PSV in 1 month and 6 months after operation between the two groups（ P 〈0.05）.The decline rate of ovarian function in the suture group was 0.0%,which was lower than 10.53% in the electric coagulation group and the difference was statistically significant（ P 〈0.05）.Conclusions：The damage of laparoscopic suture hemostasis in laparoscopic ovarian cystectomy to ovarian tissue and blood vessels is less with quick recovery.It is an ideal method of hemostasis and decreases the influence on residual ovarian function with normal serum sex hormones,AFC and PSV in 6 months after operation.