垂体后叶素对卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响

Effect of vasopressin injection technique on ovarian reserve in patients with ovarian endometriosis cysts excision

目的 探讨垂体后叶素对腹腔镜单侧卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响.方法 选取单发卵巢子宫内膜异位囊肿患者70例,采用随机数字表法分为研究组（37例）与对照组（33例）.研究组术中在卵巢囊壁间隙中注入稀释的垂体后叶素,对照组采用常规剥除囊肿双极电凝止血.对比研究组与对照组手术时间、出血量;术前及术后分别检测两组血清卵泡刺激激素（FSH）、黄体生成素（LH）、雌二醇（E2）、抗苗勒管激素（AMH）的浓度及阴道彩超探测窦状卵泡数（AFC）、卵巢间质动脉血流的收缩期峰值（PSV）以判断卵巢储备功能变化.结果 研究组手术时间为（37.6±8.6）min、对照组手术时间为（42.8±9.1）min,研究组手术时间短于对照组（t=2.46,P〈0.05）;研究组出血量为（23.2±12.1）mL,对照组出血量为（31.4±17.3）mL,研究组出血量较对照组少（t=2.32,P〈0.05）.对照组E2术前及术后分别为（201.46±7.51）pmol/L、（153.94±8.72）pmol/L,术后与术前相比显著降低（t=23.72,P〈0.01）.对照组AMH术前及术后分别为（2.31±0.79）ng/mL、（1.67±0.75）ng/mL,术后与术前相比显著降低（t=3.38,P〈0.05）.对照组FSH术前及术后分别为（6.58±2.70）U/L、（10.24±1.21）U/L,术后较术前显著升高（t=7.12,P〈0.01）.对照组LH术前及术后分别为（5.87±1.76）U/L、（6.15±2.14）U/L,手术前后差异无统计学意义（t=0.58,P〉0.05）.对照组AFC术前及术后分别为（8.7±2.8）个、（4.6±0.7）个,术后与术前相比显著降低（P〈0.05）.对照组PSV术前及术后分别为（13.8±5.9）cm/s、（7.5±2.4）cm/s,术后与术前相比显著降低（P〈0.05）.研究组E2术前及术后分别为（199.36±8.42）pmol/L、（197.12±8.33）pmol/L,术后与术前差异无统计学意义（t=1.15,P〉0.05）.研究组AMH术前及术后分别为（2.23±0.85）ng/mL、（2.19±0.83）ng/mL,术后与术前差异无统计学意义（t=0.20,P〉0.05）.研究组FSH术前及术后分别为（6.27±2.35）U/L、（6.73±2.23）U/L,术后较术前差异无统计学意义（t=0.86,P〉0.05）.研究组LH术前及术后分别为（5.92±2.32）U/L、（5.57±2.31）U/L,手术前后差异无统计学意义（t=0.65,P〉0.05）.研究组AFC术前及术后分别为（9.2±2.4）个、（8.9±2.7）个,术后与术前相比差异无统计学意义（P〉0.05）.研究组PSV术前及术后分别为（14.7±5.4）cm/s、（14.0±4.7）cm/s,术后与术前差异无统计学意义（P〉0.05）.结论 垂体后叶素用于腹腔镜卵巢子宫内膜异位囊肿剥除术是安全、有效的,可保护卵巢储备功能.

 Objective To investigate the effect of vasopressin injection technique on ovarian reserve in patients with laparoscopic cystectomy of unilateral ovarian endometrioma .Methods 70 patients with unilateral ovarian endometrioma were randomly allocated into study group （37 cases） and control group（33 cases） according to the digital table .Diluted vasopressin was injected into the space between the normal ovarian cortex and the cyst wall before stripping in the study group , and ordinary laparoscopic cystectomy without injection was adopted in control group.The average contents of anti -mullerian hormone（AMH）,follicle-stimulating hormone（FSH）,luteinizing hormone（LH）,estradiol（E2）,antral follicle count（AFC） and peak systolic velocity（PSV） were compared in two groups before and after surgery .Results The operative time of the study group was （37.6 ±8.6） min,which was significantly shorter than （42.8 ±9.1）min of the control group（t=2.46,P〈0.05）.The blood loss of the study group was （23.2 ±12.1）mL,which was significantly less than （31.4 ±17.3）mL of the control group（t=2.32,P〈0.05）.In the control group,the E2 levels preoperation and postoperative were （201.46 ±7.51）pmol/L,（153.94 ± 8.72）pmol/L,respectively,the difference was statistically significant between preoperation and postoperation （t =23.72,P〈0.05）.The AMH levels in the control group preoperation and postoperation were （2.31 ±0.79）ng/mL, （1.67 ±0.75）ng/mL,respectively,there was statistically significant difference between preoperation and postoperation （t=3.38,P〈0.05）.The FSH levels in the control group preoperation and postoperation were （6.58 ±2.70）U/L, （10.24 ±1.21）U/L,respectively,there was statistically significant difference between preoperation and postoperation （t=7.12,P〈0.05）.The LH levels in the control group preoperation and postoperation were （5.87 ±1.76）U/L, （6.15 ±2.14） U/L,respectively,there was no significant difference between preoperation and postoperation （t =0.58,P〉0.05）.The F0 levels in the control group preoperation and postoperation were （8.7 ±2.8）,（4.6 ±0.7）, respectively,there was significant difference between preoperation and postoperation （P〈0.05）.The PSV levels in the control group preoperation and postoperation were （13.8 ±5.9）cm/s,（7.5 ±2.4）cm/s,respectively,there was significant difference between preoperation and postoperation （P〈0.05）.The E2 levels in the study group preopera-tion and postoperation were （199.36 ±8.42）pmol/L,（197.12 ±8.33）pmol/L,respectively,there was no significant difference between preoperation and postoperation （t=1.15,P〉0.05）.The AMH levels in the study group preopera-tion and postoperation were （2.23 ±0.85） ng/mL,（2.19 ±0.83） ng/mL,respectively,there was no statistically significant difference between preoperation and postoperation （t=0.20,P〉0.05）.The FSH levels in the study group preoperation and postoperation were （6.27 ±2.35）U/L,（6.73 ±2.23）U/L,respectively,there was no statistically significant difference between preoperation and postoperation （t=0.86,P〉0.05）.The LH levels in the study group preoperation and postoperation were （5.92 ±2.32） U/L,（5.57 ±2.31） U/L,respectively,there was no statistically significantl difference between preoperation and postoperation （t=0.65,P〉0.05）.The F0 levels in the study group preoperation and postoperation were （9.2 ±2.4）,（8.9 ±2.7）,respectively,there was no statistically significant difference between preoperation and postoperation （P〉0.05）.The PSV levels in the study group preoperation and postoperation were （14.7 ±5.4） cm/s,（14.0 ±4.7） cm/s,respectively,there was no statistically significant difference between preoperation and postoperation （P〉0.05）.Conclusion Vasopressin injection technique used in unilateral ovarian endometrioma laparoscopic cystectomy is safe and effective ,and it can protect the ovarian reserve .