双极电凝在腹腔镜卵巢囊肿剔除术后止血中的应用效果及其对患者卵巢功能的影响

Effect of bipolar coagulation on hemostasis after laparoscopic ovarian cyst exclusion and its effect on ovarian function

目的探讨腹腔镜卵巢囊肿剔除术后采用双极电凝止血与缝合止血的临床效果及对患者卵巢功能的影响。方法选取上海交通大学医学院附属同仁医院2010年1月至2016年11月收治的行腹腔镜下卵巢囊肿剔除术患者257例,根据术中止血方式不同分为电凝组(126例)和缝合组(131例)。电凝组采用双极电凝止血,缝合组采用缝合止血,术后随访6个月。观察两组患者手术指标,术后1、3、6个月卵巢功能、卵巢内基质血流情况及月经、排卵情况。结果手术时间、术中出血量和术后引流量电凝组为(42.9±11.5)min、(58.3±17.1)m L、(69.44±11.38)m L,缝合组为(53.5±11.6)min、(81.7±11.9)m L、(57.63±10.91)m L,两组比较差异有统计学意义(P<0.05)。术后1月两组患者雌二醇(estradiol,E_2)、窦卵泡计数(antral follicle count,AFC)水平较术前下降,卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)水平较术前升高(P<0.05)。术后3月,电凝组E_2、AFC水平低于缝合组,FSH、LH水平高于缝合组(P<0.05)。术后6月两组患者E_2、AFC、FSH、LH水平与术前比较差异无统计学意义(P>0.05)。缝合组术后1、3、6月收缩期血流峰值流速(peak systolic velocity,PSV)、搏动指数(pulsating index,PI)、阻力指数(resistance index,RI)、收缩期与舒张期血流速度比值(systolic and diastolic blood flow velocity ratio,S/D)与术前比较差异无统计学意义(P>0.05);电凝组术后1、3月PSV、PI、RI、S/D值低于术前和缝合组(P<0.05)。随访6个月期间,电凝组出现9例排卵异常,14例月经过少,18例经期延长,发生率为32.54%;缝合组出现4例排卵异常,7例月经过少,10例经期延长,发生率为16.03%,两组比较差异有统计学意义(P<0.05)。结论在腹腔镜卵巢囊肿剔除术中,采用双极电凝和缝合止血短期内均会导致卵巢功能短暂衰退,但缝合止血较双极电凝止血恢复快,临床上要根据术中不同情况选取合适的止血方式。

Objective To investigate the clinical effect of bipolar coagulation on hemostasis after laparoscopic ovarian cyst exclusion and its effect on ovarian function. Methods 257 patients underwent laparoseopic ovarian cyst exelusion in Tongren Hospital Affiliated of Medicine College of Shanghai Jiaotong University School from January 2010 to November 2016 were divided into electrocoagulation group（ 126 cases） and suture group（ 131 cases） according to different hemostatic methods. Electroacupuncture group used bipolar coagulation hemostasis while suture group used suture hemostasis, following up for 6 months, compared the two groups of patients with surgical indicators, ovarian function, ovarian matrix blood flow and menstrual, ovulation situation 1,3,6 months after surgery. Results The operative time, intraoperative blood loss and postoperative drainage were （ 42. 9 ± 11.5 ） min, （ 58.3 ± 17.1） mL, （69.44 ± 11.38） mL, （53.5 ± 11.6） mininthe suture group, （53.5±11.6）min,（81.7±11.9）mL,（57.63± 10. 91 ） mL in the electrocoagulation group, the differences between the two groups were statistically significant（ P 〈 0. 05 ）. The levels of estradiol （ E2 ） and antral follicle eount （ AFC ） in the two groups were lower than those before operation. The follicle stimulating hormone（FSH） and luteinizing hormone （LH） were higher than those before operation （P 〈 0. 05 ）. The levels of E2 and AFC in eleetrocoagulation group were lower than those in suture group, and the levels of FSH and LH were higher than those of suture group（ P 〈 0. 05）. There were no significant differenees in E2 , AFC, FSH and LH between the two groups 6 months after operation （ P 〉 0. 05 ）. The systolic blood flow peak velocity （ PSV ） , pulsatility index （ PI ） ,resistanee index （ RI ） , systolic and diastolic blood flow velocity（S/D） in the suture group had no signifieant differences 1, 3 and 6 months after operation compared with preoperative. The PSV, PI, RI and S/D values of electrocoagulation group were lower than those of preoperative and suture group（ P 〈 0.05 ）. During the follow- up period of 6 months, there were 9 eases of abnormal ovulation, 14 eases of menstruation less, 18 eases of menstrual extension in eleetrocoagulation group, the ineidence was 32. 54 % ; 4 cases of ovulation abnormalities ,7 cases of menorrhagia, 10 cases of menstrual extension in suture group ,the incidence was 16. 03 % ,the differences between the two groups were statistically significant （ P 〈 0. 05 ）. Conclusion In the laparoscopic ovarian cyst exclusion surgery, the use of bipolar coagulation and suture hemostasis can lead to short - term decline of ovarian function, but suture hemostasis can recover more quickly than bipolar coagulation hemostasis. In clinic we should select the appropriate hemostatic way according to the different circumstances of surgery.