不同止血方式对育龄期卵巢良性囊肿患者腹腔镜剥除术后卵巢功能及妊娠结局的影响

Effects of different hemostasis methods on ovarian function and pregnancy outcomes of patients with benign ovarian cysts of childbearing age after laparoscopic stripping

目的:探讨电凝止血与缝合止血对育龄期卵巢良性囊肿患者腹腔镜剥除术后卵巢功能及妊娠结局的影响。方法:将180例育龄期卵巢良性囊肿患者随机分为两组,其中90例腹腔镜剥除术中采用电凝止血(电凝组),90例采用缝合止血(缝合组);于术前、术后6个月的月经周期第3天查血卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2),行超声测定双侧卵巢的窦卵泡数;观察记录术后6个月内月经紊乱发生情况,并随访术后2年内妊娠情况。结果:术后6个月,电凝组FSH、LH、E2及窦卵泡数与术前相比,差异有统计学意义(P<0.05),而缝合组FSH、LH、E2及窦卵泡数与术前相比,差异无统计学意义(P>0.05);电凝组FSH、LH水平明显高于缝合组(P<0.05),E2及窦卵泡数明显低于缝合组(P<0.05)。术后6个月内,电凝组月经紊乱发生率为20.00%,明显高于缝合组的8.89%(P<0.05)。随访2年,缝合组妊娠率为75.56%,高于电凝组的58.89%,差异有统计学意义(P<0.05)。结论:在腹腔镜卵巢囊肿剥除术中应用缝合止血,相比于电凝止血的安全性更高,对卵巢功能保护较好,有助于提高术后妊娠率。

Objective:To explore the effects of electrocoagulation hemostasis and suture hemostasis on ovarian function and pregnancy outcomes of patients with benign ovarian cysts of childbearing age after laparoscopic stripping.Methods:180 patients with benign ovarian cysts of childbearing age were randomly divided into two groups.Among them,90 patients were given electrocoagulation hemostasis in laparoscopic stripping(electrocoagulation group),and 90 patients were given suture hemostasis(suture group).On the third day of menstrual cycle before operation and at 6 months after operation,the blood follicle stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)were examined.The number of antral follicles in bilateral ovaries was measured by ultrasound.The occurrence of menstrual disorders was observed and recorded within 6 months after operation.The pregnancy was followed up within 2 years after operation.Results:At 6 months after operation,the levels of FSH,LH and E2 and the number of antral follicles in electrocoagulation group were significantly different from those before operation(P<0.05),and the levels of FSH,LH and E2 and the number of antral follicles in suture group were not statistically different from those before operation(P>0.05).The levels of FSH and LH in electrocoagulation group were significantly higher than those in suture group(P<0.05),while the level of E2 and the number of antral follicles were significantly lower than those in suture group(P<0.05).Within 6 months after operation,the incidence rate of menstrual disorders in electrocoagulation group was significantly higher than that in suture group(20.00%vs.8.89%,P<0.05).At 2 years of follow-up,the pregnancy rate in suture group was significantly higher than that in electrocoagulation group(75.56%vs.58.89%,P<0.05).Conclusion:In laparoscopic stripping of ovarian cysts,suture hemostasis has higher safety and better protection of ovarian function,and helps to improve the postoperative pregnancy rate compared with electrocoagulation hemostasis.