腹腔镜下卵巢囊肿剥除术对不同性质卵巢囊肿患者卵巢储备功能的影响

Effect of laparoscopic ovarian cystectomy onthe ovarian reserve function of patients with different types of ovarian cysts

目的探讨采用缝合止血的腹腔镜下卵巢囊肿剥除术对不同性质卵巢囊肿患者卵巢储备功能的影响。方法选取2014年1月至2016年6月在解放军第163医院进行手术的75例卵巢囊肿患者为研究对象。将其分为三组:第一组为双侧卵巢子宫内膜异位囊肿患者,第二组为单侧卵巢子宫内膜异位囊肿患者,第三组为单侧其他良性囊肿患者,每组均为21例患者。所有患者均采用缝合止血的腹腔镜下卵巢囊肿剥除术,观察各组患者术后卵巢储备功能情况。结果与术前比较,三组患者术后6个月、12个月各项检测指标差异均无统计学意义(均P>0.05);与术前相比,第一组患者术后1个月的FSH、LH升高,E2、INHB、AMH、AFC下降,差其异均具有统计学意义(均P<0.05);与术前相比,第二组患者术后1个月的E2、INHB、AMH下降,其差异均具有统计学意义(均P<0.05);第三组患者术后1个月的E2下降,其差异具有统计学意义(P<0.05)。组间两两比较,第二组与第三组之间各项指标差异均无统计学意义(均P>0.05)。第一组患者术后1个月的FSH水平明显高于第二组,其差异具有统计学意义(P<0.05);E2、AMH、AFC水平均低于第二组和第三组,其差异均具有统计学意义(均P<0.05)。结论腹腔镜下卵巢囊肿剥除术中应用缝合止血,对3种性质的卵巢囊肿患者卵巢储备功能具有一定影响,双侧卵巢子宫内膜异位囊肿患者卵巢储备功能下降最为严重,但并不影响远期卵巢储备功能。

Objective To explore the effects of laparoscopic ovarian cystectomy with suturing and hemostasis on the ovarian reserve function of patients with different types of ovarian cysts. Methods 75 patients with ovarian cysts who underwent surgery in People′s Liberation Army 163 Central Hospital from January 2014 to June 2016 were selected. They were divided into three groups:the first group of patients with bilateral ovarian endometrioma(21 cases), the second group of patients with unilateral ovarian endometriosis(21 cases) and the third group of patients with unilateral benign cysts(21 cases). All patients underwent laparoscopic ovarian cystectomy with suture and hemostasis. The ovarian reserve function was observed in each group. Results Compared with preoperative situation, there was no statistically significant difference in the detection indexes of the three groups at 6 months and 12 months after the operation(all P>0.05). Compared with preoperative situation, levels of FSH and LH in the first group increased at a month after operation, while levels of E2, INHB, AMH and AFC decreased, with statistically significant difference(all P<0.05). Compared with preoperative situation, levels of E2, INHB and AMH in the second group decreased at a month after operation(P<0.05);levels of E2 in the third group decreased at a month after operation(P<0.05). There was no statistically significant difference between the second group and the third group(all P>0.05). FSH level in the first group was significantly higher than that in the second group at a month after operation, with statistically significant difference(P<0.05). Levels of E2, AMH, and AFC in the first group were lower than those in the second group and third group, with statistically significant differences(all P<0.05). Conclusions The use of suturing and hemostasis in laparoscopic ovarian cystectomy has certain effects on the ovarian reserve function in patients with three types of ovarian cysts. Through the ovarian reserve function is decreased most severely in patients with bilateral ovarian endometriosis, it does not affect the long-term ovarian reserve function.