腹腔镜下卵巢囊肿剥除术中缝合止血对残留卵巢功能的保护作用

Protective effect of suture hemostasis on residual ovarian function during laparoscopic ovarian cystectomy

目的 探讨腹腔镜下卵巢囊肿剥除术中缝合止血对残留卵巢功能的保护作用.方法 选取104例卵巢囊肿患者,随机分为观察组与对照组,每组52例.两组均行腹腔镜下卵巢囊肿剥除术,观察组术中采取缝合止血,对照组术中采取电凝止血.比较两组出血量、止血前后的每搏量（SV）、心输出量（CO）、平均动脉压（MAP）,术前及术后6个月的雌二醇（E 2）、黄体生成素（LH）、血清卵泡刺激素（FSH）及卵巢储备功能减弱、卵巢功能早衰、月经异常等并发症发生率.结果 两组出血量[（52.37±6.87）ml比（54.05±7.02）ml]比较差异未见统计学意义（P〉0.05）;两组止血前SV、CO、MAP、E 2、LH、FSH比较差异均未见统计学意义（P〉0.05）,止血后观察组SV、CO、MAP未见明显变化,对照组止血后SV、CO及MAP有所增高,且高于观察组（P〈0.05）.术后6个月两组LH无明显变化（P〉0.05）,E 2均下降、FSH均升高（P〈0.05）.观察组术后6个月的E 2高于对照组、FSH低于对照组（P〈0.05）.观察组卵巢储备功能减弱、卵巢功能早衰与月经异常等并发症总发生率（9.62％）明显低于对照组（26.92％,P〈0.05）.结论 腹腔镜下卵巢囊肿剥除术中采取缝合止血可充分保留卵巢血供,减轻对卵巢组织的损伤,对残余卵巢功能起到保护作用,降低术后卵巢储备功能减弱、卵巢功能早衰、月经异常风险,值得推广.

Objective To investigate the protective effect of suture hemostasis on residual ovari-an function in laparoscopic ovarian cystectomy. Methods One hundred and four patients with ovarian cyst were randomly divided into observation group and control group,with 52 cases in each group. The two groups underwent laparoscopic ovarian cystectomy,the observation group took suture hemostasis, while the control group took electrocoagulation to stop bleeding. The blood loss,stroke volume （SV）be-fore and after hemostasis,cardiac output （CO）before and after hemostasis,mean arterial pressure （MAP）before and after hemostasis,Estradiol levels （E 2 ）before and 6 months after operation,luteini-zing hormone （LH）before and 6 months after operation,serum follicle stimulating hormone （FSH）be-fore and 6 months after operation,the incidence of ovarian reserve function weakened,premature ovarian failure,menstrual abnormalities were compared between the two groups. Results There was no signifi-cant difference in blood loss [（52. 37 ± 6. 87）ml vs. （54. 05 ± 7. 02）ml]between the two groups （P 〉0. 05）. There were no significant difference in SV,CO,MAP before hemostasis and preoperative E 2 , LH,FSHbetween the two groups （P 〉 0. 05）. There was no significant change in SV,CO or MAP in the observation group after hemostasis;and after hemostasis SV,CO and MAP in the control group were higher,which were higher than the observation group （P 〈 0. 05）. There was no significant change of LH in the two groups （P 〉 0. 05）,while the E 2 decreased and FSH increased in the two groups 6 months af-ter treatment （P 〈 0. 05）. The level of E 2 of the observation was higher than that of the control group, and the level of FSH was lower than that of the control group 6 months after treatment （P 〈 0. 05）. The overall incidence of complications such as ovarian function premature rupture and menstrual abnormalities in the observation group （9. 62%）was significantly lower than that of the control group （26. 92%,P 〈0. 05）. Conclusions In laparoscopic ovarian cyst resection,taking suture hemostasis can fully retain o-varian blood supply,reduce the ovarian tissue damage,has the protective effect on residual ovarian func-tion,reduce the postoperative ovarian reserve function weakening,premature ovarian failure,abnormal menstruation risk,and is worthy of promotion.