不同止血方式对腹腔镜下卵巢子宫内膜异位囊肿剥除术者卵巢功能的影响

Effect of different hemostatic methods on ovarian function of patients undergoing laparoscopic cystectomy For ovarian endometrioma

目的探讨腹腔镜下卵巢子宫内膜异位囊肿剥除术中采用双极电凝及缝合两种止血方式对卵巢储备功能的影响,为腹腔镜下卵巢子宫内膜异位囊肿剥除术中止血方式的选择提供依据。方法将180位行腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术的患者随机分为缝合组和电凝组各90例,缝合组采用缝合止血,电凝组采用双极电凝止血.比较两组术中出血量、手术时间及术后肛门排气时间;测定患者血清FSH、E2、LH及AMH水平;测定双侧卵巢体积(OV)、卵巢间质动脉血流的收缩期峰值(PSV)及窦卵泡数(Fo)。结果缝合组手术时间、术中出血量显著多于电凝组(P<0.05)。与术前相比,两组患者术后血清FSH、LH水平显著上升,E2、AMH水平则显著下降(P<0.05);术后第1、6个月,电凝组血清FSH、LH水平显著高于缝合组,而E2、AMH水平则显著低于缝合组(P<0.05)。术后第1、6个月,与健侧相比,两组患者的OV减小、PSV减慢、Fo减少(P<0.05);同时,缝合组OV显著大于电凝组,PSV快于电凝组,Fo多于电凝组(P<0.05)。结论腹腔镜下卵巢子宫内膜异位囊肿剥除术会导致患者卵巢储备功能受损;相比于电凝止血,缝合止血对卵巢储备功能影响较小。

Objective To explore the effects of hemostasis by bipolar coagulation and suture during laparoscopic cystectomy for ovarian endometrioma on ovarian reserve,thus to provide evidence for the hemostasis choice during laparoscopic cystectomy for ovarian endometrioma. Methods A total of 180 patients undergoing laparoscopic unilateral cystectomy for ovarian endometrioma were randomly divided into suture group and coagulation group,with 90 cases in each group. Hemostasis by suture and bipolar coagulation were performed in the suture group and coagulation group respectively. The intraoperative blood loss,operative duration and postoperative exhaust time were compared between the two groups. The serum levels of follicle stimulating hormone（ FSH）,estradiol（ E2）,luteinizing hormone（ LH） and anti-Mullerian hormone（ AMH）were detected in the patients. The bilateral ovarian volume（ OV）,the peak systolic value（ PSV） of ovarian stromal blood flow and antral follicle count（ AFC） were measured. Results The intraoperative blood loss,operative duration of the suture group were significantly more or longer than those of the coagulation group（ P 0. 05）. In both groups,the serum FSH and LH levels significantly increased but the E2 and AMH levels significantly decreased after operation compared to the preoperative levels（ P 0. 05）. At the first and sixth months after operation,the serum FSH and LH levels were significantly higher but the E2 and AMH levels were significantly lower in the coagulation group compared to the group（ P 0. 05）. At the first and sixth months after operation,the OV,PSV and AFC of the affected sides decreased in both groups compared to the normal sides（ P 0. 05）,and these indices also significantly increased in the suture group compared to the coagulation group（ P 0. 05）. Conclusion Laparoscopic cystectomy for ovarian endometrioma can cause impaired ovarian reserve. Compared to hemostasis by coagulation,hemostasis by suture has less effect on the ovarian reserve.