单孔腹腔镜与多孔腹腔镜卵巢囊肿剔除术临床疗效及术后卵巢储备功能的对比研究

A Comparative Study on the Clinical Efficacy and Ovarian Reserve Function of Single-hole Laparoscopic and Porous Laparoscopic Ovarian Cyst Excision

目的:比较单孔腹腔镜与多孔腹腔镜卵巢囊肿剔除术的临床疗效及对术后卵巢储备功能的影响。方法:采用前瞻性病例对照研究,选取2018年6月-2019年5月在本院行卵巢囊肿剔除术的患者84例。根据手术方法不同分为单孔腹腔镜卵巢囊肿剥除术组(单孔组,42例)和多孔腹腔镜卵巢囊肿剔除术组(多孔组,42例)。比较两组手术时间、术中出血量、住院时间、术后Hb下降幅度、术后24 h发热的最高体温,手术前后血清抗苗勒式管激素(AMH)、促卵泡激素(FSH)、促黄体生成素(LH)及雌二醇(E2)水平变化。采用疼痛视觉模拟评分(VAS)评价患者疼痛程度,采用身体意象问卷(BIQ)评价手术切口的美观满意度。结果:两组手术时间、术中出血量、住院时间、术后Hb下降幅度及术后24 h发热的最高体温比较,差异均无统计学意义(P>0.05)。术后,两组AMH水平低于术前,但两组间比较,差异无统计学意义(P>0.05)。术前及术后1、3个月,两组患者血清FSH、LH及E2水平比较,差异均无统计学意义(P>0.05)。术后1个月,两组的血清FSH、LH水平均较术前上升,E2水平均较术前下降(P<0.05);术后3个月,两组的AMH、FSH、LH及E2水平均有所恢复。术后单孔组VAS评分低于多孔组,差异有统计学意义(P<0.05);单孔组BIS评分、CS评分均显著高于多孔组,差异均有统计学意义(P<0.05)。结论:单孔腹腔镜下卵巢囊肿剔除术可减轻患者术后疼痛,更为美观。

Objective:To compare the clinical effect of single-hole laparoscopy and porous laparoscopy in the treatment of ovarian cyst excision and its effect on postoperative ovarian reserve function.Method:A prospective case-control study was conducted in 84 patients who underwent ovarian cyst excision in our hospital from June 2018 to may 2019.According to different surgical methods,the patients were divided into the single-hole laparoscopic ovarian cyst excision group(single-hole group,42 cases)and the porous laparoscopic ovarian cyst excision group(porous group,42 cases).The operation time,intraoperative blood loss,length of hospital stay,decrease of Hb,maximum temperature of fever 24 hours after operation,and changes of serum levels of anti Mullerian hormone(AMH),follicle stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)were compared between the two groups.Visual analogue scale(VAS)and body image questionnaire(BIQ)were used to evaluate the aesthetic satisfaction of surgical incision.Result:There were no significant differences in operation time,intraoperative blood loss,hospital stay,postoperative Hb decrease and the highest temperature of fever 24 h after operation between the two groups(P>0.05).After operation,the levels of AMH in the two groups were lower than those before operation,but there was no significant difference between the two groups(P>0.05).There were no significant differences in serum FSH,LH and E2 levels between the two groups before and 1,3 months after operation(P>0.05).1 month after operation,the levels of serum FSH and LH in the two groups were higher than those before operation,and the level of E2 were lower than those before operation(P<0.05).The levels of AMH,FSH,LH and E2 in both groups recovered 3 months after operation.VAS score in the single-hole group was lower than that in the porous group,the difference was statistically significant(P<0.05).BIS scores and CS scores of the single-hole group were significantly higher than those of the porous group,the differences were statistically significant(P<0.05).Conclusion:Single-hole laparoscopic ovarian cyst excision can relieve postoperative pain and be more beautiful.