腹腔镜下卵巢囊肿剥除术不同止血方式对残留卵巢功能的影响

Effects of different hemostatic methods in laparoscopic excision of ovarian cyst on residual ovarian function

目的:分析腹腔镜下卵巢囊肿剥除术不同止血方式对残留卵巢功能的影响并总结止血经验。方法:选取行腹腔镜下卵巢囊肿剥除术的患者48例,按入院顺序分为电凝组、缝合组各24例,分别采用双极电凝、缝合法进行卵巢切口止血。对比术前、术后1个月、6个月的月经周期2～3 d的卵巢功能指标,计划妊娠者成功妊娠率。结果 :电凝组术后1个月E2高于术前、缝合组,电凝组术后1个月、6个月的FSH高于术前与同期缝合组,电凝组术后6个月AFC低于缝合组(P <0.05)。两组不同时间段LH组间及组内对比差异无统计学意义(P> 0.05)。随访(11±6)个月,缝合组计划妊娠的对象成功妊娠21.4%(3/14),对照组16.7%(2/12),差异无统计学意义(P> 0.05)。结论:腹腔镜下卵巢囊肿剥除术双极电凝止血对残留卵巢功能损伤更大,但对妊娠能力影响与缝合无显著差异。

Objective:To analyze the effects of different hemostatic methods in laparoscopic excision of ovarian cysts on residual ovarian function and summarize hemostatic experience.Methods:Forty-eight cases of patients undergoing ovarian cyst excision under laparoscope were divided into an electrocoagulation group and a suture group with 24 cases each according to the order of their admission.Hemostasis of ovarian incision was performed by bipolar electrocoagulation or suture,respectively.The ovarian function indicators on the day 2-3 of menstrual cycles before surgery,at the first and sixth months after surgery and the successful rate of the planned pregnancy were compared.Results:The E2 value at the first month after surgery and the level of FSH at the first and sixth months after surgery were higher in the electrocoagulation group than the suture group and also after operation than before,however,the AFC level at the sixth month after surgery was lower in the electrocoagulation group than the suture group(P<0.05).There were no significant differences in LH at different time periods between the two groups(P>0.05).Follow-up for 11±6 months showed that the successful pregnancy rate was 21.4%(3/14)in the suture group and 16.7%(2/12)in the control group without significant differences(P>0.05).Conclusion:The effect of bipolar coagulation on residual ovarian function was more serious when undergoing laparoscopic exfoliation of ovarian cyst,but there were no significant differences in pregnancy ability compared with suture.