缝合法单双电凝与超声刀止血对腹腔镜下卵巢子宫内膜异位囊肿剥除术患者卵巢功能及预后的影响

Effect of Suture,Monopolar and Bipolar Electrocoagulation and Ultrasonic Knife in Hemostasis on Ovarian Function and Prognosis of Patients Undergoing Laparoscopic Ovarian Endometriosis Cyst Excision

目的:探究缝合法、单、双电凝与超声刀止血对腹腔镜下卵巢子宫内膜异位囊肿剥除术患者卵巢功能及预后的影响。方法:回顾性分析我院2017年5月至2019年4月期间收治的卵巢子宫内膜异位囊肿患者133例的临床资料,根据在常规腹腔镜卵巢子宫内膜异位囊肿切除术中所采取的止血方式分为缝合组(36例)、单极电凝组(32例)、双极电凝组(30例)、超声刀组(35例)。观察四组患者术后1个月、3个月、6个月、12个月时的卵泡刺激素(follicle stimulating hormone,FSH)、窦状卵泡计数(sinusoidal follicle count,AFC)水平,并在12个月后随访记录患者月经改变和妊娠结局。结果:术后1、3、6、12个月四组患者的卵泡刺激素(FSH)水平均逐渐升高,且术后12个月缝合组FSH水平显著低于超声组、单极电凝组、双极电凝组(P<0.05);术后1、3、6、12个月单极电凝组FSH水平显著高于超声刀组,且显著低于双极电凝组,组间比较存在统计学差异(P<0.05)。术后1个月所有患者窦状卵泡计数(AFC)水平降低,术后3、6、12个月逐渐升高,组内比较存在统计学差异(P<0.05)。缝合组患者自然妊娠例数为30例(83.33%),显著高于单极电凝组、双极电凝组和超声刀组,存在统计学差(P<0.05);缝合组患者月经异常例数为3例(8.33%),显著低于单极电凝组、双极电凝组和超声刀组,存在统计学差(P<0.05)。结论:单极电凝、双极电凝和超声刀止血都会对腹腔镜下卵巢囊肿剥除术患者的卵巢功能产生较大伤害,严重影响预后效果,可采用缝合止血方式保护卵巢正常血运和储存功能。

Objective:To investigate the effect of suture,monopolar and bipolar electrocoagulation and ultrasonic knife in hemostasis on ovarian function and prognosis of patients undergoing laparoscopic excision of endometriosis cyst.Methods:The clinical data of 133 patients with ovarian endometriosis cyst from May 2017 to April 2019 were analyzed retrospectively.Based on the hemostatic methods adopted in routine laparoscopic ovarian endometriosis cyst resection,the patients were divided into suture group(36 cases),monopolar electrocoagulation group(32 cases),bipolar electrocoagulation group(30 cases)and ultrasonic knife group(35 cases).The follicle stimulating hormone(FSH)and the sinusoidal follicle count(AFC)were observed at 1 month,3 months,6 months and 12 months after operation.And menstrual changes and pregnancy outcomes were recorded in the follow-up 12 months after operation.Results:The level of follicle stimulating hormone(FSH)in the four groups at 1,3,6 and 12 months after operation was gradually increased,and the FSH level in the suture group at 12 months after operation was significantly lower than those in the other groups(P<0.05).The level of sinusoidal follicle count(AFC)decreased in all patients at 1 month after operation,and gradually increased at 3,6 and 12 months after operation.There was a statistical difference in the groups(P<0.05).The number of natural pregnancy cases in the suture group was 30(83.33%),which was significantly higher than that in the monopolar group,the bipolar group and the ultrasonic knife group(P<0.05),and the number of abnormal menstrual cases in the suture group was 3(8.33%),which was significantly lower than that in the other three groups(P<0.05).Conclusion:Monopolar electrocoagulation,bipolar electrocoagulation and ultrasonic knife hemostasis can cause great harm to the ovarian function of patients undergoing laparoscopic ovarian cystectomy,and seriously affect the prognostic effect.