腹腔镜卵巢囊肿剔除术后应用双极电凝止血的效果及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2016年1月-2018年1月本院收治的行腹腔镜下卵巢囊肿剔除术患者130例。根据术中止血方式不同分为电凝组(n=65,双极电凝止血)和缝合组(n=65,缝合止血)。比较两组手术相关指标,卵巢功能(E2、AFC、AMH、FSH、LH)、卵巢内基质血流情况(PSV、PI、RI、S/D值)及月经、排卵情况。结果:电凝组手术时间、术中出血量、术后引流量均低于缝合组(P<0.05);术后1个月,两组E2、AFC、AMH水平均低于术前,FSH、LH水平均高于术前,差异均有统计学意义(P<0.05),但两组上述指标比较,差异均无统计学意义(P>0.05);术后3个月,电凝组E2、AFC、AMH水平均低于术前及缝合组,FSH、LH水平均高于术前及缝合组,差异均有统计学意义(P<0.05),但缝合组上述指标与术前比较,差异均无统计学意义(P>0.05);术后1、3个月,电凝组PSV、PI、RI、S/D值均低于术前及缝合组(P<0.05),但缝合组上述指标与术前比较,差异均无统计学意义(P>0.05);术后随访12个月,两组排卵、月经异常情况总发生率比较,差异无统计学意义(P>0.05)。结论:在腹腔镜卵巢囊肿剔除术中,双极电凝止血效果优于缝合止血,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。

Objective:To investigate the clinical effect of bipolar coagulation on hemostasis after laparoscopic ovarian cyst exclusion and its effect on ovarian function.Method:A total of 130 patients underwent laparoscopic ovarian cyst exclusion in our hospital from January 2016 to January 2016 were selected.According to the different ways of hemostasis during operation,they were divided into electrocoagulation group(n=65,bipolar coagulation hemostasis)and suture group(n=65,suture hemostasis).The operation-related indexes,ovarian function(E2,AFC,AMH,FSH,LH),intraovarian stromal blood flow(PSV,PI,RI,S/D),menstruation and ovulation between two groups were compared.Result:The operation time,intraoperative bleeding volume and postoperative drainage volume in electrocoagulation group were lower than those of suture group(P<0.05).1 month after operation,the levels of E2,AFC and AMH in two groups were lower than those of before operation,and the levels of FSH and LH were higher than those of before operation,the differences were statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).3 months after operation,the levels of E2,AFC and AMH in electrocoagulation group were lower than those of before operation and suture group,and the levels of FSH and LH were higher than those of before operation and suture group,the differences were statistically significant(P<0.05),but the above indexes in suture group were compared with before operation,the differences were not statistically significant(P>0.05).1 and 3 months after operation,the PSV,PI,RI and S/D in electrocoagulation group were lower than those of before operation and suture group(P<0.05),but the above indexes in suture group were compared with before operation,the differences were not statistically significant(P>0.05).After 12 months of follow-up,there was no significant difference in the total incidence of ovulation and menstrual abnormalities between two groups(P>0.05).Conclusion:In laparoscopic ovarian cyst removal,bipolar coagulation hemostasis is superior to suture hemostasis,bipolar coagulation and suture hemostasis can cause short-term deterioration of ovarian function,but suture hemostasis recovers faster than bipolar coagulation hemostasis.