腹腔镜下卵巢囊肿剥除术中2种止血方式对卵巢储备和生育功能的影响

Impact of Two Hemostasis Methods on Ovarian Reserve and Fertility Function in Laparoscopic Ovarian Cystectomy

目的探讨腹腔镜下卵巢囊肿剥除术中电凝止血与缝合止血对卵巢储备功能和生育能力的影响。方法选择某院2015年3月1日-2017年3月1日收治的76例行腹腔镜下卵巢囊肿剥除术的双侧卵巢囊肿患者按止血方法随机分为2组:缝合组38例和电凝组38例。所有患者行手术病理检查。分别于术前、术后1个月和术后6个月采集3次静脉血,采用电化学发光免疫分析法测定血清卵泡刺激素(FSH)、黄体生成素(LH)和雌二醇(E2)。阴道超声分别于术前及术后6个月检查卵巢间质动脉血流收缩期峰值流速(PSV)及窦卵泡数(AFC),并于术后6个月时测量卵巢最大直径。术后随访2年,观察有生育意愿患者的妊娠情况。结果缝合组术后1个月、6个月E2水平略有下降,FSH水平略有升高。而电凝组术后1个月E2水平明显下降,FSH水平明显升高;术后6个月,E2和FSH略有恢复,提示卵巢储备有所恢复。缝合组与电凝组比较,术后1个月、6个月E2和FSH水平差异均有统计学意义(P<0.05)。术后6个月,缝合组与电凝组AFC、PSV差异有统计学意义(P<0.05)。术后随访2年发现2组间妊娠率无明显差异(P>0.05)。结论腹腔镜下卵巢囊肿剥除术中,电凝止血对卵巢储备的负面影响大于缝合止血。术中应尽量减少电凝止血,对卵巢创面应采用缝合止血。

Objectives To investigate the effects of two hemostasis methods: electrocoagulation versus suture, on ovarian reserve and fertility in laparoscopic ovarian cystectomy. Methods 76 patients with bilateral ovarian cysts who underwent laparoscopic ovarian cystectomy from March 1, 2015 to March 1, 2017 were randomly divided into two groups according to hemostasis methods: suture group(38 cases) and electrocoagulation group(38 cases). All patients underwent surgical and pathological examination. Venous blood was collected three times before operation, one month after operation and six months after operation. Serum follicle stimulating hormone(FSH), luteinizing hormone(LH) and estradiol(E2) were measured by electrochemiluminescence immunoassay. The Peak systolic flow velocity(PSV) of interstitial ovarian artery and the number of antral follicles(AFC) were examined by transvaginal ultrasound before and 6 months after operation, respectively. The maximum ovarian diameter was measured at 6 months after operation. After two years of follow-up, the pregnancy of patients with fertility intention was observed. Results In suture group, E2 level decreased slightly and FSH level increased slightly 1 and 6 months after operation. In the electrocoagulation group, the level of E2 decreased and the level of FSH increased significantly at 1 month after operation, while the level of E2 and FSH recovered slightly at 6 months after operation, suggesting that ovarian reserve recovered.There were significant differences in E2 and FSH levels between suture group and electrocoagulation group 1 and6 months after operation(P< 0.05). AFC and PSV were significantly different between suture group and electrocoagulation group 6 months after operation(P< 0.05). Two years follow-up showed no significant difference in pregnancy rate between the two groups(P > 0.05). Conclusions In laparoscopic ovarian cystectomy, the negative effect of electrocoagulation hemostasis on ovarian reserve was greater than that of suture hemostasis. During operation, electrocoagulation should be minimized to stop bleeding, and suture should be used to stop bleeding on ovarian wounds.