腔镜下常规钝性剔除和改良锐性剥离术式治疗子宫内膜异位症对患者卵巢体积、窦卵泡数、性激素水平影响

Effects of conventional blunt excision and modified sharp peeling treatment on ovarian volume, number of antral follicles and sex hormone levels in patients with endometriosis

目的探讨在子宫内膜异位症患者中采用腹腔镜下常规钝性剔除和改良锐性剥离术式对患者术后卵巢体积、窦卵泡数、性激素水平的不同影响。方法回顾性分析2014年3月~2017年5月我院妇产科收治的卵巢子宫内膜异位症患者126例,按术式选择方法不同分为腹腔镜下常规钝性剔除术组(对照组,61例)和改良锐性剥离术组(观察组,65例),对比分析两组患者术后患侧卵巢体积及窦卵泡数、血清性激素水平。结果术前,两组患侧卵巢体积、窦卵泡数比较,差异无统计学意义(P>0.05);术后6个月,两组患侧卵巢体积均较术前明显缩小,但观察组缩小程度小于对照组,差异有统计学意义(P<0.05);术后6个月,观察组患侧窦卵泡数与术前比较,差异无统计学意义(P>0.05),但明显多于对照组术后,差异有统计学意义(P<0.05)。术前,两组血清FSH、LH、E_2水平比较,差异无统计学意义(P>0.05);术后6个月,两组血清FSH、LH、E_2水平分别与组内术前比较,差异无统计学意义(P>0.05),与组间术后比较,差异无统计学意义(P>0.05)。结论卵巢子宫内膜异位症患者采用腹腔镜下行改良锐性剥离术既有效剥除卵巢门附近紧密粘连的囊壁组织,同时有效保护残留卵巢功能,与常规钝性剔除术更具有临床优越性。

Objective To investigate the effects of conventional blunt excision and modified sharp peeling treatment on ovarian volume, number of antral follicles and sex hormone levels in patients with endometriosis. Methods One hundred and twenty-six cases of ovarian endometriosis treated in department of obstetrics and gynecology of our hospital from March 2014 to May 2017 were analyzed retrospectively. According to the different operation methods, the patients were divided into laparoscopic conventional blunt excision group（control group, 61 cases） and modified sharp peeling treatment group（observation group, 65 cases）. The contralateral ovarian volume, number of antral follicles and serum sex hormone levels of two groups were compared. Results There was no significant difference in ovarian volume on the affected side and number of antral follicles between the two groups before operation（P 〉0.05）. Six months after operation, the ovarian volume on the affected side of the two groups was significantly smaller than that before operation, but the reduction degree of the observation group was smaller than that of the control group, the difference was statistically significant（P 〈0.05）. Six months after operation, there was no significant difference in the number of follicular follicles on the affected side of the observation group than that before operation（P 〉0.05）, but the difference was significantly more than that in the control group after operation（P 〈0.05）.Before operation, there was no significant difference in serum FSH, LH and E2 levels between the two groups（P 〈0.05）. Six months after operation, the serum levels of FSH, LH and E2 in the two groups were not significantly different from preoperative compared with before operation（P 〉0.05）, and here was no significant difference between the two groups after operation （P 〉0.05）. Conclusion Ovarian endometriosis patients with laparoscopic modified sharp peeling treatment not only effectively peel off the close adhesion of the ovarian door near the wall tissue, but also effectively protect the residual ovarian function, which is more clinically superior to conventional obtuse removal.