腹腔镜下卵巢囊肿剔除术中电凝和缝合止血对卵巢储备功能的影响

Effects of electrocoagulation and suture hemostasis in laparoscopic oophorocystectomy on ovarian reserve function

目的探讨腹腔镜下卵巢囊肿剔除术中电凝和缝合止血对卵巢储备功能的影响。方法选取2018年1月—2020年11月青海省人民医院收治的卵巢囊肿患者200例作为研究对象,随机分为电凝组和缝合组,每组100例。比较两组患者手术前后抗缪勒管激素(AMH)、雌二醇(E2)、促卵泡激素(FSH)、黄体生成素(LH)水平,并分析其相关性。结果电凝组与缝合组手术时间、术中出血量比较,差异无统计学意义(P>0.05)。术后1个月,两组窦卵泡数、卵巢动脉收缩期峰值血流速度少或慢低于术前(P<0.05);且缝合组多或快于电凝组(P<0.05)。两组血清AMH、E2水平均低于术前(P<0.05),且缝合组高于电凝组(P<0.05)。两组血清FSH、LH水平均高于术前(P<0.05);且缝合组低于电凝组(P<0.05)。Pearson相关性分析结果显示,术后血清AMH与E2水平呈正相关(r=0.553,P<0.05),与FSH、FSH/LH呈负相关(r=-0.614和-0.482,均P<0.05),与LH无相关性(r=0.115,P>0.05)。结论相较电凝止血,腹腔镜下卵巢囊肿剔除术中应用缝合止血更有利于保护卵巢储备功能。患者术后血清AMH水平与E2、FSH、FSH/LH相关,AMH检测可作为辅助手段评价患者术后卵巢储备功能。

Objective To investigate the effects of different hemostasis methods on ovarian reserve function in laparoscopic oophorocystectomy.Methods Two hundred patients with ovarian cyst undergoing laparoscopic oophorocystectomy in our hospital from January 2018 to November 2020 were randomly divided into electrocoagulation group(n=100)and suture group(n=100).The levels of anti-Mullerian hormone(AMH),estradiol(E2),follicle stimulating hormone(FSH)and luteinizing hormone(LH)before and after operation were compared between the two groups,and their correlations were analyzed.Results There was no difference in operative duration and intraoperative blood loss between the two groups(P>0.05).One month after operation,the antral follicle count(AFC)and peak systolic velocity(PSV)in the two groups were lower than those before operation(P<0.05),and those in the suture group were higher than those in the electrocoagulation group(P<0.05).The serum levels of AMH and E2 in the two groups after operation were lower than those before operation(P<0.05),and those in the suture group were higher than those in the electrocoagulation group(P<0.05).The serum levels of FSH and LH in the two groups after operation were also higher than those before operation(P<0.05),and those in the suture group were lower than those in the electrocoagulation group(P<0.05).Pearson correlation analysis showed that serum AMH level was positively correlated with E2 level(r=0.553,P<0.05),negatively correlated with FSH level and FSH/LH ratio(r=-0.614 and-0.482,both P<0.05),but not correlated with LH level(r=0.115,P>0.05).Conclusions Compared with electrocoagulation,suture hemostasis is more conducive to the protection of ovarian reserve function in laparoscopic oophorocystectomy.The level of serum AMH is correlated with E2 level,FSH level and FSH/LH ratio,and the detection of AMH can be used as an auxiliary approach to evaluating the ovarian reserve function.