腹腔镜卵巢囊肿剥除术中电凝与缝合止血对患者术后疼痛及血清5-HT、P物质影响

Effect of electrocoagulation and suture hemostasis during laparoscopic ovarian cystectomy on post-operation pain and serum 5-HT and PS

目的:探讨腹腔镜卵巢囊肿剥除术中电凝与缝合止血对患者术后疼痛及血清5-羟色胺(5-HT)、P物质(PS)影响。方法:将2017年1月—2018年9月来本院诊治的120例卵巢良性囊肿患者随机分为两组,均行腹腔镜剥除术,其中60例术中采用电凝止血(电凝组),60例采用缝合止血(缝合组);分别于术后12h、24h及48h对患者进行疼痛视觉模拟(VAS)评分,比较两组手术前后血清5-羟色胺(5-HT)及PS水平;于术前、术后2个月的月经周期第3d查血卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2),超声测定双侧卵巢窦卵泡数;随访术后1年妊娠情况。结果:缝合组术后VAS评分12h(3.67±1.12分)、24h(3.12±0.92分)均低于电凝组(4.41±1.26分、3.76±1.14分)(P<0.05),血清5-HT(3.76±1.14 nmol/L)、PS(51.25±14.63 pg/ml)水平均低于电凝组(487.54±125.74 nmol/L、76.58±16.78 pg/ml)(P<0.05)。术后2个月,缝合组FSH、LH、E2及窦卵泡数与术前相比无差异(P>0.05),电凝组FSH、LH水平高于缝合组,E2及窦卵泡数低于缝合组(P<0.05)。随访1年,缝合组妊娠率(65.0%)高于电凝组(45.0%)(P<0.05)。结论:腹腔镜卵巢囊肿剥除术中应用缝合止血比电凝止血可更好地抑制血清5-HT、PS表达,减轻患者术后疼痛,并有助于保护残留卵巢功能,提高术后妊娠率。

Objective:To explore the effect of electrocoagulation and suture hemostasis for treating women with ovarian cysts after laparoscopic ovarian cystectomy on their pain situation and the levels of serum serotonin(5-HT)and substance P(PS).Methods:120 women with benign ovarian cysts were randomly divided into two groups.Among them,60 women in the study group had undergone electrocoagulation hemostasis during laparoscopic ovarian cystectomy and 60 women in control group had undergone suture hemostasis during laparoscopic ovarian cystectomy.The scores of visual analogue scale(VAS)of women in both groups were evaluated at 12h,24h and 48h after surgery.The levels of serum 5-HT and PS of women before and after surgery were compared between the two groups.Before surgery and on the 3rd day of the second menstrual cycle after surgery,the levels of serum follicle stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)of women in the two groups were detected.Ultrasound was used to determine number of antral follicles in bilateral ovaries of all women.The pregnancy situation of women in the two groups was followed up in 1 year after surgery.Results:The VAS scores of women in the control group at postoperative 12h and 24h were 3.67±1.12 points and 3.12±0.92 points,which were significant lower than those(4.41±1.26 points and 3.76±1.14 points)of women in the study group(P<0.05).The levels of serum 5-HT and PS of women in the control group were 3.76±1.14 nmol/L and 51.25±14.63 pg/ml,which were significant lower than those(487.54±125.74 nmol/L and 76.58±16.78 pg/ml)of women in the study group(P<0.05).2 months after the operation,the levels of serum FSH,LH,and E2,and sinus follicle numbers of women in the control group had no significant different from those before the operation(P>0.05),and the levels of FSH and LH of women in the study group were significant higher than those of women in the control group,while the E2 level and the number of antral follicles of women in the study group were significant lower(P<0.05).After 1 year of followed up,the pregnancy rate of women in the control group(65.0%)was significant higher than that(45.0%)of women in the study group(P<0.05).Conclusion:Compared with electrocoagulation hemostasis,suture hemostasis during laparoscopic ovarian cystectomy can inhibit expression of serum 5-HT and PS,alleviate postoperative pain,help to protect residual ovarian function,and improve postoperative pregnancy rate.