腹腔镜卵巢成熟畸胎瘤剥除术电凝或缝合止血对患者卵巢储备功能影响

Influence of electric coagulation hemostasis compared with suture hemostasis during laparoscopic ovarian maturation teratoma excision of the patients on their ovarian reserve function

目的:比较腹腔镜卵巢成熟畸胎瘤剥除术电凝止血与缝合止血对患者卵巢储备功能的影响。方法:选取2016年5月—2021年5月本院收治的80例因卵巢畸胎瘤行腹腔镜下卵巢畸胎瘤剔除术患者,随机数字法随机分为两组各40例,分别采用双极电凝止血方法(电凝止血组)或缝合止血方法(缝合止血组),记录两组手术时间、术中出血量,检测术前末次月经的第3天、术后3天及术后1个月、6个月患者月经第3天时血清雌二醇(E_(2))、促卵泡激素(FSH)、黄体生成素(LH)及抗苗勒管激素(AMH),在术前及术后1、6个月取血当天行经阴道超声记录窦卵泡数(F0)、卵巢体积及患侧卵巢间质血流峰值(PSV)。结果:两组手术时间和术中出血量无差异(P>0.05)。术后3天、1个月、6个月的E_(2)及AMH水平两组均低于术前,但缝合止血组高于电凝止血组;FSH水平两组均高于术前,但缝合止血组低于电凝止血组(均P<0.05);LH水平两组均高于术前(P<0.05),但两组无差异(P>0.05)。两组术后1个月、6个月超声F0均低于术前,但缝合止血组高于电凝止血组(均P<0.05),卵巢体积及PSV缝合止血组较术前回升,电凝止血组下降,缝合止血组卵巢体积及PSV均高于电凝止血组(均P<0.05)。结论:腹腔镜成熟畸胎瘤剥除术中采用缝合止血方法比电凝止血法更有利于保护卵巢储备功能及术后恢复。

Objective:To compare the influence of electric coagulation hemostasis and the suture hemostasis of patients who underwent laparoscopic ovarian maturation teratoma excision on their ovarian reserve.Methods:From May 2016 to May 2021,80 patients who wanted laparoscopic excision of ovarian teratoma were selected and were randomly divided into two groups(40 cases in each group).The patients in group A were given intraoperative coagulation hemostasis,and the patients in group B were given intraoperative suture hemostasis.The operation time and the amount of intraoperative bleeding of the patients in the two groups were recorded.The levels of estradiol(E_(2)),follicle stimulating hormone(FSH),luteinizing hormone(LH),and anti Mullerian hormone(AMH)of the patients on the third day of the last menstrual period before surgery,on the third day after operation,and on the third day of the menstrual cycle in 1 or 6 months after operation were detected.Before operation and postoperative 1 and 6 months,transvaginal ultrasound were used to record antral follicles count(AFC),ovarian volume,and psilateral ovarian stromal blood flow peak(PSV)value.Results:There were no significant differences in operative time and intraoperative blood loss of the patients between the two groups(P>0.05).The levels of E_(2) and AMH of the patients in the two groups in 3 days,1 and 6 months after operation were significant lower than those before operation,but which of the patients in group B were significant higher than those of the patients in group A.The level of FSH of the patients in the two groups after operation was significant higher than that before operation,but which of the patients in group B was significant lower than that of the patients in group A(all P<0.05).The LH level of the patients in the two groups after operation was significant higher than that before operation(P<0.05),but there was no significant difference in the LH level of the patients between the two groups(P>0.05).In 1 or 6 months after operation,AFC of the patients by ultrasound in the two groups was significant lower than that before operation,but which of the patients in group B was significant higher than that of the patients in group A(all P<0.05).The ovarian volume and PSV value by ultrasound of the patients in group B were significant higher than those before operation,but which of the patients in group A had decreased significantly.The ovarian volume and PSV value by ultrasound of the patients in group B were significant higher than those of the patients in group A(all P<0.05).Conclusion:Compared with that of coagulation hemostasis,suture hemostasis during laparoscopic ovarian maturation teratoma excision can better protect the ovarian reserve and is help to the recovery after operation.