腹腔镜下卵巢囊肿剥除术后创面双极电凝和缝合止血对残留卵巢储备功能的影响

Effect of haemostasis by bipolar electrocoagulation versus suture following laparoscopic oophorocystectomy

目的:分析腹腔镜下卵巢囊肿剥除术后创面双极电凝和缝合止血对残留卵巢储备功能的影响。方法:选取双侧卵巢巧克力囊肿患者105例,随机分为缝合组(n=53)和电凝组(n=52),观察患者手术情况及术后卵巢储备功能下降情况,比较卵巢门近、远端促卵泡激素(FSH)、雌二醇(E2)、黄体生成素(LH)水平以及窦卵泡计数(AFC)。结果:两组患者手术顺利,未见感染或并发症发生。术后6个月,电凝组卵巢门近端囊肿患者FSH、LH水平较术前明显升高,E2水平及AFC明显降低(P<0.01),且FSH、LH水平明显高于缝合组,E2、AFC明显低于缝合组,差异有统计学意义(P<0.01)。术前及术后6个月,两组卵巢门远端囊肿患者FSH、E2、LH水平及AFC比较,差异无统计学意义(P>0.05)。两组术后卵巢储备功能下降情况比较,差异无统计学意义(P>0.05)。结论:对于卵巢门远端的囊肿,建议选择操作简便的双极电凝止血;对于卵巢门近端的囊肿,首选缝合止血。

Objective:To explore the effect of haemostasis by bipolar electrocoagulation versus suture following laparoscopic oophorocystectomy.Methods:Totally 105 patients with bilateral ovarian chocolate cyst were selected,and randomly divided into suturing group ( n =53) and bipolar electrocoagulation group ( n =52).The operation condition and occurrence of diminished ovarian reserve were observed between two groups,and the levels of follicle-stimulating hormone (FSH),estradiol (E 2) and luteinizing hormone (LH) as well as antral follicle count (AFC) at proximal and distal ovarian hilum were compared between two groups.Results:The operation of two groups was successful,and no infection or complications occurred.6 months after operation,the levels of FSH and LH went up obviously,while that of E 2 level and AFC down conspicuously in the patients with cysts at proximal ovarian hilum when compared with pre-operation ( P <0.01).The levels of FSH and LH were higher,whereas E 2 level and AFC were lower markedly in the patients with cysts at proximal ovarian hilum than those in suturing group,with statistical significance ( P <0.01).There was no statistical significance in the patients with cysts at distal ovarian hilum between two groups regarding the FSH,E 2,LH levels and AFC before and 6 months after operation ( P >0.05).Additionally,no significant difference was shown between two groups with respect to the occurrence of diminished ovarian reserve ( P >0.05).Conclusion:For the cysts at distal ovarian hilum,bipolar electrocoagulation with simple operations should be selected for haemostasis,for the cysts at proximal ovarian hilum,it's better to select the suture for haemostasis.