腹腔镜卵巢良性囊肿剥除术中不同止血方式对患者卵巢储备功能及性激素水平和免疫功能的影响

Effect of different hemostasis on ovarian reserve function,sex hormone level and immune function in patients undergoing laparoscopic benign ovarian cystectomy

目的探讨腹腔镜卵巢良性囊肿剥除术中不同止血方式对患者卵巢储备功能、性激素水平及免疫功能的影响。方法选择2016年6月至2018年9月秦皇岛市妇幼保健院收治的120例卵巢良性囊肿患者为研究对象,所有患者接受腹腔镜卵巢囊肿剥除术,其中60例患者术中采用缝合止血(缝合止血组),另外60例患者术中采用双极电凝止血(电凝止血组)。记录2组患者的手术时间、术中出血量、术后排气时间及住院时间;分别于术前及术后第1天采用流式细胞仪检测2组患者CD3^+、CD4^+和CD8^+水平;术前及术后6个月,检测2组患者血清雌二醇(E 2)、卵泡刺激素(FSH)和黄体生成素(LH)水平,并应用彩色多普勒超声仪测量2组患者卵巢最大直径(MOD)和窦卵泡计数(AFC)。结果电凝止血组患者手术时间显著短于缝合止血组(P<0.05),术中出血量显著少于缝合止血组(P<0.05);2组患者术后排气时间、住院时间比较差异无统计学意义(P>0.05)。2组患者术前CD3^+、CD4^+及CD8^+水平比较差异均无统计学意义(P>0.05);2组患者术后第1天CD3^+、CD4^+和CD8^+水平均显著低于术前(P<0.05);术后第1天,缝合止血组患者CD3^+、CD4^+和CD8^+水平均低于电凝止血组(P<0.05)。2组患者术前MOD、AFC比较差异均无统计学意义(P>0.05);2组患者术后6个月MOD显著小于术前(P<0.05),AFC显著少于术前(P<0.05);术后6个月,电凝止血组患者MOD显著小于缝合止血组(P<0.05),AFC显著少于缝合止血组(P<0.05)。2组患者术前血清E 2、FSH及LH水平比较差异均无统计学意义(P>0.05);术后6个月,2组患者血清E 2、FSH及LH水平均显著高于术前(P<0.05);电凝止血组患者血清E 2、FSH及LH水平均显著高于缝合止血组(P<0.05)。结论缝合止血有利于保护患者卵巢储备功能,而双极电凝止血手术时间短、出血量少、术后患者免疫功能较好,临床上应结合患者实际情况选择适合的止血方式。

Objective To investigate the effect of different hemostasis on ovarian reserve function,sex hormone level and immune function in patients undergoing laparoscopic benign ovarian cystectomy.Methods A total of 120 patients with benign ovarian cysts admitted to Maternal and Child Health Hospital of Qinhuangdao from June 2016 to September 2018 were selected as the study subjects.All patients underwent laparoscopic ovarian cystectomy,60 patients underwent suture hemostasis(suture hemostasis group),and the other 60 patients underwent bipolar electrocoagulation hemostasis(electrocoagulation hemostasis group).The operation time,intraoperative bleeding volume,postoperative exhaust time and hospitalization time of patients in the two groups were recorded.The levels of CD3^+,CD4^+and CD8^+were measured by flow cytometry before and on the first day after operation.The levels of serum estradiol(E 2),follicle stimulating hormone(FSH)and luteinizing hormone(LH)were measured;and the maximum ovarian diameter(MOD)and antral follicle count(AFC)were measured by color Doppler ultrasound before and at 6 months after operation.Results The operation time in the electrocoagulation hemostasis group was significantly shorter than that in the suture hemostasis group,and the intraoperative bleeding volume was significantly less than that in the suture hemostasis group(P<0.05).There was no significant difference in the postoperative exhaust time and hospitalization time between the two groups(P>0.05).There was no significant difference in the level of CD3^+,CD4^+and CD8^+between the two groups before treatment(P>0.05).The level of CD3^+,CD4^+and CD8^+on the first day after operation were significantly lower than those before operation in the two groups(P<0.05).The levels of CD3^+,CD4^+and CD8^+in the suture hemostasis group were lower than those in the electrocoagulation hemostasis group on the first day after operation(P<0.05).There was no significant difference in the MOD and AFC between the two groups before treatment(P>0.05).The MOD at six months after operation was significantly shorter than that before operation,and the AFC was significantly less than that before operation in the two groups(P<0.05).At six months after operation,the MOD in the electrocoagulation hemostasis group was significantly shorter than that in the suture hemostasis group,and the AFC in the electrocoagulation hemostasis group was significantly less than that in the suture hemostasis group(P<0.05).There was no significant difference in the level of serum E 2,FSH and LH between the two groups before operation(P>0.05).The levels of serum E 2,FSH and LH at six months after operation were significantly higher than those before operation in the two groups(P<0.05).The levels of serum E 2,FSH and LH in the electrocoagulation hemostasis group were significantly higher than those in the suture hemostasis group at six months after operation(P<0.05).Conclusion Suture hemostasis is beneficial to protect ovarian reserve function,while bipolar electrocoagulation hemostasis has shorter operation time,less intraoperative bleeding volume and better postoperative immune function.The suitable hemostasis methods should be selected according to the actual situation of patients.