腹腔镜下卵巢囊肿剥除术中垂体后叶素-水囊分离法对卵巢功能的保护作用

The protective effect of hydrodissection with diluted vasopressin in laparoscopic cystectomy of ovarian cyst

目的探讨垂体后叶素-水囊分离法在腹腔镜下卵巢囊肿剥除术中对卵巢功能的保护作用。方法选取妇科行腹腔镜下单侧卵巢囊肿剥除术的患者90例,分为垂体后叶素组(术中局部应用稀释的垂体后叶素)、生理盐水组(术中局部应用生理盐水)和空白对照组(直接剥除囊肿),每组30例,比较3组患者手术时间、手术前后血红蛋白下降量及手术前后血清AMH值的变化。结果垂体后叶素组、生理盐水组与空白对照组比较,手术时间、手术前后血红蛋白下降量减少,但差异无统计学意义(P>0.05);术后1个月、3个月、6个月,3组患者血清AMH值均较术前降低,差异有统计学意义(P<0.05);术后1个月、3个月垂体后叶素组、生理盐水组AMH值大于空白对照组,且二者比较差异有统计学意义(P<0.05);术后1个月、3个月垂体后叶素组与生理盐水组比较,差异无统计学意义(P>0.05)。术后6个月3组患者血清AMH值不同,垂体后叶素组较空白对照组AMH值高,差异有统计学意义(P<0.05)。结论腹腔镜下卵巢囊肿剥除术后卵巢储备功能会降低,使用垂体后叶素水囊分离有保护卵巢功能的作用,具有一定的临床实用价值。

Objective To investigate the protective effect on ovarian reserve of a new surgical technique,hydrodissection with diluted vasopressin,in laparoscopic cystectomy of ovarian cyst. Methods The patients diagnosed as ovarian cyst was divided into three groups to undergo laparoscopic cystectomy ： group 1 （ n = 30, hydrodissection with diluted vasopressin）, group 2 （ n = 30,hydrodissection with saline） and group 3 （n = 30,routine laparoscopic cystectomy）. Ovarian hemostasis was achieved by bipolar electrocoagulation. And the operative time,changes in hemoglobin level and the level of serum AMH,most important,was compared among 3 groups. Results The operative time, changes in hemoglobin level in group 1 and group 2 were less than those in group 3, but there is no difference （ P 〉 0.05 ）. The AMH was decreased in 1 months,3 months and 6 months after surgery （P 〈 0.05）. Furthermore,in group 1 and group 2,AMH was not decreased as much as group 3 （P 〈0.05）. There is no difference between group 1 or group 2 in ovarian function 1 or 3 months after operation （P 〈 0. 05 ）. However, after 6 months of operation, the level of serum AMH in group 1 was higher than that in other two groups. Conclusion The use of vasopressin in shelling out ovarian cysts under laparoscopy can make it easier,protect ovarian reserve better.