子宫内膜异位囊肿去顶术与腹腔镜卵巢囊肿切除术对卵巢储备的影响研究

The effect of laparoscopic endometriosis cyst decapitation and ovarian cyst resection on ovarian reserve

目的探讨子宫内膜异位囊肿去顶术与腹腔镜下卵巢囊肿切除术对卵巢储备的影响。方法选择2017年1月至2019年1月我院收治的卵巢子宫内膜异位囊肿患者80例,按照随机数字表法分为腹腔镜下去顶术组40例和卵巢囊肿切除术组40例;观察比较术后两组患者临床指标如月经、围手术期体征、盆腔疼痛转归、卵巢体积、两年自然妊娠率等。结果所有患者均手术成功。去顶术组手术时间和术中出血量均低于卵巢囊肿切除术组(P<0.05),两组腹腔引流管放置率、住院时间、术后疼痛情况比较差异无统计学意义(P>0.05);去顶术组卵巢体积、窦卵泡数明显大于去卵巢囊肿切除术组(P<0.01),两组月经周期延长、月经量减少的发生率差异有统计学意义(P<0.05);去顶术组自然妊娠率高于卵巢囊肿切除术组(P<0.05),术后8~10 cm囊肿复发率高于卵巢囊肿切除术组(P<0.05)。结论子宫内膜异位囊肿去顶术操作简单,安全性高,可增加自然妊娠率,不增加术后复发率,可作为治疗卵巢子宫内膜异位囊肿有效方法;但是超过10 cm的囊肿不建议行去顶术。

Objective To investigate the effects of laparoscopic endometrial cyst decapitation and ovarian cyst resection on ovarian reserve.Methods Eighty patients with ovarian endometriosis cyst treated in our hospital from January 2017 to January 2019 were randomly divided into a laparoscopic endometrial cyst decapitation group and an ovarian cyst resection group,40 in each group.Clinical indexes such as menstruation,perioperative signs,pelvic pain,ovarian volume,and two-year natural pregnancy rate of the two groups were observed and compared.Results All patients had successful surgery.The operation time and intraoperative bleeding in the laparoscopic endometrial cyst decapitation group were lower than those in the ovarian cyst resection group(P<0.05).There was no significant difference in the placement rate of abdominal drainage tube,length of hospital stay and postoperative pain between the two groups(P>0.05).The ovarian volume and the number of antral follicles in the laparoscopic endometrial cyst decapitation group were significantly higher than those in the ovarian cyst resection group(P<0.01).There was a significant difference in the incidence of prolonged menstrual cycle and decreased menstrual volume between the two groups(P<0.05).The natural pregnancy rate in the laparoscopic endometrial cyst decapitation group was higher than that in the ovarian cyst resection group(P<0.05).However,the recurrence rate of 8~10 cm cysts after operation in the laparoscopic endometrial cyst decapitation group was higher than that in the ovarian cyst resection group(P<0.05).Conclusion Decapitation of endometriosis cyst has the advantages of simple operation and high safety.It can increase the natural pregnancy rate without increasing the postoperative recurrence rate.It can be used as an effective method for the treatment of ovarian endometriosis cyst.However,this type of surgery is not recommended for cysts over 10 cm.