双极电凝止血在腹腔镜卵巢子宫内膜异位囊肿剥除术中的应用

Application of bipolar coagulation hemostasis in laparoscopic ovarian endometriosis cyst stripping

目的：探讨腹腔镜卵巢子宫内膜异位囊肿剥除术应用双极电凝止血对卵巢功能的影响。方法选取2015年1月至2016年2月治疗的卵巢子宫内膜异位囊肿患者88例，采用数字表法随机分为观察组和对照组，每组44例。观察组给予双极电凝止血，对照组给予镜下缝合。检测并比较两组术前、术后及术后6个月黄体生成素（LH）、促卵泡生成素（FSH）、雌二醇（E2）、窦状卵泡数（FO ）和卵巢基质收缩期血流速度峰值（PSV）。结果观察组术后及术后6个月 E2分别为（190．03±30．88）pmol／L、（179．82±29．94）pmol／L，明显低于对照组的（230．04±32．22）pmol／L、（232．49±28．41）pmol／L（t ＝5．947、9．465，均 P 〈0．05）；观察组术后及术后6个月 FSH 分别为（12．01±2．10）mIU ／mL、（12．09±1．99）mIU ／mL，明显低于对照组的（9．20±2.08）mIU ／mL、（9．18±1．10）mIU ／mL（t ＝6．306、8．489，均 P 〈0．05）；观察组术后及术后6个月 LH 分别为（9.93±1．73）mIU ／mL、（9．81±1．78）mIU ／mL，明显高于对照组的（8．94±1．80）mIU ／mL、（9．03±1．91）mIU ／mL （t ＝2．630、1．982，均 P 〈0．05）；观察组术后及术后6个月 FO 分别为（7．60±1．85）个、（8．81±1．23）个，均明显低于对照组的（8．77±1．90）个、（9．43±1．44）个（t ＝2．927、2．172，均 P 〈0．05）；观察组术后及术后6个月PSV 分别为（0．07±0．02）m／s、（0．09±0．01）m／s，均明显低于对照组的（0．09±0．01）m／s、（0．12±0．01）m／s （t ＝5．933、14．071，均 P 〈0．05）；观察组卵巢储备功能下降共有6例（13．64％），对照组为5例（11．36％），两组差异无统计学意义（P 〉0．05）。结论腔镜卵巢子宫内膜异位囊肿剥除术中不同止血方式对卵巢储备功能均有影响，但双极电凝止血可致卵巢储备功能明显下降，在术中应尽量少使用。

Objective To investigate the effect of bipolar coagulation hemostasis on ovarian function in patients with laparoscopic ovarian endometriosis cyst stripping.Methods From January 2015 to February 2016, 88 cases of ovarian endometriosis cyst were selected by using the random number table method.They were randomly divided into observation group and control group,44 cases in each group.The observation group was treated with bipolar coagulation hemostasis,and the control group was treated with endoscopic suturing.The luteinizing hormone（LH）, follicle stimulating hormone（FSH）,estradiol（E2 ）,sinus follicle number（FO ）and ovarian stroma systolic blood flow velocity peak preoperation,postoperation and postoperative 6 months were detected.Results The E2 levels in the observation group postoperation and postoperative 6 months were （190.03 ±30.88 ）pmol/L and （179.82 ± 29.94）pmol/L,which were significantly lower than those in the control group [（230.04 ±32.22 ）pmol/L and （232.49 ±28.41）pmol/L,t =5.947,9.465,all P 〈0.05].The FSH levels in the observation group postoperation and postoperative 6 months were （12.01 ±2.10）mIU /mL and （12.09 ±1.99）mIU /mL,which were significantly higher than those in the control group[（9.20 ±2.08）mIU /mL and （9.18 ±1.10）mIU /mL,t =6.306,8.489,all P 〈0.05].The LH levels in the observation group postoperation and postoperative 6 months were （9.93 ±1.73）mIU /mL and （9.81 ±1.78）mIU /mL,which were significantly higher than those in the control group[（8.94 ±1.80）mIU /mL and （9.03 ±1.91）mIU /mL,t =2.630,1.982,P 〈0.05].The FO levels in the observation group postoperation and postoperative 6 months were （7.60 ±1.85）and （8.81 ±1.23）,which were significantly lower than those in the control group[（8.77 ±1.90）and （9.43 ±1.44）,t =2.927,2.172,all P 〈0.05].The PSV levels in the observation＆amp;nbsp;group postoperation and postoperative 6 months were （0.07 ±0.02）m/s and （0.09 ±0.01）m/s,which were signifi-cantly lower than those in the control group[（0.09 ±0.01）m/s and （0.12 ±0.01）m/s,t =5.933,14.071,all P 〈0.05].The ovarian reserve function in the observation group decreased in 6 cases（13.64%）,which in the control group was 5 cases（11.36%）,the difference was not statistically significant（P 〉0.05）.Conclusion The application of different hemostatic methods in laparoscopic ovarian endometriosis cyst stripping have effect on ovarian reserve function,but bipolar coagulation and hemostasis can significantly decrease ovarian reserve function,and it should be used as little as possible during the operation.