腹腔镜下卵巢囊肿剥除术中缝合止血对患者卵巢储备功能和性激素水平与基质血流的影响

Effect of suture hemostasis in laparoscopic oophorocystectomy on the ovarian reserve function,sex hormone levels and stromal blood flow

目的分析腹腔镜下卵巢囊肿剥除术中缝合止血对患者卵巢储备功能、性激素水平及基质血流的影响。方法选取2019年3月~2020年4月在首都医科大学附属北京同仁医院行腹腔镜下卵巢囊肿剥除术治疗者106例,根据患者术中止血方式不同分为对照组(电凝止血)51例和观察组(缝合止血)55例。对比两组患者手术前后卵巢储备功能[窦状卵泡数目(AFC)、患侧卵巢动脉收缩期时峰值血流速度(PSV)]、性激素水平[刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)],基质血流[卵巢基质搏动指数(PI)、阻力指数(RI)、舒张期最低流速(EDV)、收缩期与舒张末期的血流速度比值(S/D)]及应激指标[皮质醇(Cor)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)]水平变化情况。结果手术前两组卵巢储备功能、性激素水平及基质血流、应激指标比较差异均无统计学意义(均P>0.05),术后对照组AFC降低(P<0.05),观察组AFC与术前比较差异无统计学意义(P>0.05),两组PSV均降低,观察组AFC、PSV均高于对照组(均P<0.05)。观察组FSH、LH水平明显低于对照组,E2水平高于对照组(P<0.05);两组术后PI、RI、EDV均降低,S/D增加(P<0.05),而观察组PI、RI、S/D低于对照组,EDV值高于对照组(均P<0.05);两组术后Cor、ACTH、NE高于手术前,其中观察组Cor、ACTH、NE水平均低于对照组(P<0.05)。结论腹腔镜下卵巢囊肿剥除术中缝合止血可保护患者卵巢储备功能,稳定卵巢基质血流,缓解应激反应,为理想的止血方式。

Objective To analyze the effect of suture hemostasis in laparoscopic oophorocystectomy on the ovarian reserve function,sex hormone levels and stromal blood flow.Methods 106 patients who underwent laparoscopic ovarian cyst removal in this hospital from March 2019 to April 2020 were selected and divided into control group(electrocautery)51 cases and observation group(sutures hemostasis)according to the different methods of hemostasis during the operation.The ovarian reserve function[Antral follicle(AFC),peak systolic blood flow velocity(PSV)of the affected ovarian artery],sex hormone levels[Follicle stimulating hormone(FSH),Luteinizing hormone(LH),Estradiol(E2)],stromal blood flow[pulsatility index(PI)of stroma of ovary,resistance index(RI),diastolic minimum velocity(EDV),the ratio of systolic blood flow velocity to end-diastolic blood flow velocity(S/D)]and stress indicators[cortisol(Cor),adrenocorticotropic hormone(ACTH),and norepinephrine(NE)]before and after surgery were compared between the two groups.Results There were no differences in ovarian reserve,sex hormone levels,stromal blood flow,and stress indicators between the two groups before surgery(P>0.05).After operation,the AFC of the control group decreased,but there was no significant difference in the observation group compared with that before the operation(P>0.05).The PSV of the two groups decreased.The AFC and PSV of the observation group were higher than those of the control group(P<0.05).The FSH and LH levels of the observation group were significantly lower than those of the control group,and the E2 level was higher than that of the control group(P<0.05).After surgery,PI,RI,EDV decreased,and S/D increased,while PI,RI,S/D of the observation group were lower than those of the control group,and the EDV value was higher than that of the control group(P<0.05).The levels of Cor,ACTH and NE after surgery in the two groups were higher than those before surgery,and the levels of Cor,ACTH and NE in the observation group were lower than those in the control group(P<0.05).Conclusion Suture hemostasis during laparoscopic ovarian cystectomy can protect the patient's ovarian reserve function,stabilize the blood flow of the ovarian stroma,and alleviate the stress response,which is an ideal hemostasis method.