腹腔镜下卵巢囊肿剔除70例临床观察

Clinical observation on 70 cases undergoing oophorocystectomy under peritoneoscope

目的总结分析腹腔镜下卵巢囊肿剔除术的手术经验及临床疗效。方法将诊断为卵巢囊肿(单侧)的70例患者设为观察组(腹腔镜组),按照止血方法的不同分为:双极电凝组40例,缝合组30例,对照组(开腹组):选取同期行开腹卵巢囊肿(单侧)剔除术的35例单侧卵巢囊肿患者,比较三组患者手术时间(min)、术中出血(ml)、术后肛门首次排气时间(d),术后半年随访,观察三组患者外周血清性激素(FSH、LH、E2)的变化评估患者的卵巢功能的影响。结果腹腔镜组患者手术时间、术中出血量、排气时间、治疗效果均优于开腹组,差异有统计学意义(P<0.05)。术前各组患者血清FSH、LH和E2含量相似,差异无显著性(P>0.05)。术后6个月时,各组患者的血清FSH和LH含量均较术前明显升高(P<0.05),E2含量均较术前明显下降(P<0.05),双极电凝组和对照组患者FSH、LH升高和E2下降程度最明显(P<0.05),明显多于镜下缝合组,双极电凝组患者FSH、LH升高和E2下降程度明显多于对照组(P<0.05)。结论腹腔镜下卵巢囊肿瘤剔除术具有手术时间短,微创,术后康复快等优点,腹腔镜下缝合止血手术方法能够有效的保护患者卵巢功能,该手术方案值得临床推广应用。

Objective To analyse operational experience and clinical effect of oophorocystectomy under peritoneoscope. Methods 70 Patients who were diagnosed with ovarian cyst （unilateral） were randomly chosen as an observation group or lapamseopic group, and then according to the different hemostatic methods they were further divided into bipolar electric coagulation group for 40 cases and anastomosis group for 30 cases. On the other hand, 35 patients with unilateral ovarian cyst who have ovarian cyst （unilateral） at the Same period were selected as a control group or open surgery group. Operation time, intraoperative hemorrhage volume, postoperative anal exhaust time for the first time were compared between three groups. Six months later, follow-ul~ visit was carried out, and changes of peripheral blood sex hormones （FSH, LH, E2） were observed to assess the effect on ovarian function among three groups. Results Operation time, intraoperative blood loss, exhaust time, treatment effect in laparoscopic group are superior to open surgery group, the difference is statistically significant （P 〈 0.05）. Preoperative serum FSH, LH, and E2 levels are similiar in all groups, and there were no significant differences （P 〉 0.05）. 6 months after operation, FSH and LH＇s amount in all groups were higher than those before operation （P 〈 0.05） and E2 value was decreased （P 〈 0.05）. For the bipolar electric coagulation group and control group, the increase of FSH, LH value and the decrease of E2 are the most obvious （P 〈 0.05）, those values were significantly more than those in anastomosis group. FSH, LH values in bipolar electric coagulation group were increased more than those in control group while E2 was decreased significantly than that in control group （P 〈 0.05）. Conclusion oophorocystectomy under peritoneoscope is a kind of operation with shorter operation time, minimally invasion, recovering quickly. Suture hemostasis operating method under peritoneoscope can protect patients＇ovarian function and is worthy of clinical application.