同步水降温电凝止血法在腹腔镜卵巢囊肿剥除术中的应用

Application of Synchronous Water-cooling Bipolar Coagulation in Laparoscopic Ovarian Cystectomy

目的探讨同步水降温电凝止血(简称同步水降温止血)法对腹腔镜卵巢囊肿剥除术(LOC)患者卵巢储备功能的影响。方法选取2018年1月至2020年1月在深圳大学附属第二医院行LOC的156例卵巢良性肿瘤患者为研究对象,按随机数字表法分为缝合止血组、电凝止血组、同步水降温止血组,每组52例。比较3组手术时长、术中出血量、术后排气时间、住院天数、病理类型;观察3组患者术前末次月经(T0)、术后第3次月经(T3)和第6次月经(T6)来潮的第2天血清卵泡刺激素(FSH)、抗苗勒管激素(AMH)及T3、T6第5天基础窦卵泡数(AFC)的变化情况。结果3组手术均顺利完成,随访至术后6个月均无复发。3组手术时间、排气时间、病理类型、术后T3及T6的FSH比较,差异无统计学意义(P>0.05)。与缝合止血组比较,电凝止血组和同步水降温止血组术中出血量明显降低(P<0.05)。与缝合止血组和电凝止血组比较,同步水降温止血组住院天数明显降低(P<0.05)。缝合止血组和同步水降温止血组术后AMH、AFC与术前相比均无明显下降(P>0.05)。同步水降温止血组和缝合止血组术后T3和T6的AMH、AFC比较,差异无统计学意义(P>0.05)。与缝合止血组和同步水降温止血组比较,电凝止血组术后T3和T6的AMH、AFC明显降低(P<0.05)。结论在LOC中采用同步水降温止血法可保护卵巢储备功能,减少术中出血。

Objective To explore the effect of synchronous water-cooling bipolar coagulation during laparoscopic ovarian cystectomy(LOC)on ovarian reserve in patients with benign ovarian tumors.Methods A total of 156 patients with benign ovarian tumor undergoing LOC in the Second Affiliated Hospital of Shenzhen University from January 2018 to January 2020 were selected as the study subjects.According to random number table method,they were divided into 3 groups:suture hemostasis group(n=52),bipolar coagulation group(n=52)and synchronous water-cooling bipolar coagulation group(n=52).Duration of operation,intraoperative blood loss,postoperative exhaust time,hospital stay,pathologic type and the changes of follicle stimulating hormone(FSH),and anti-Müllerian hormone(AMH)on the second day of the last menstruation before operation(T0),postoperative third menstruation(T3)and sixth menstruation(T6)as well as antral follicle counting(AFC)on the fifth day of T3 and T6 were recorded and compared among the 3 groups.Results The operations of 3 groups were successfully completed in one stage.No recurrence was found during 6 months of follow-up after operation.There was no significant difference in the duration of operation,exhaust time,pathological type and postoperative FSH of T3 and T6 among the three groups(P>0.05).The amount of intraoperative blood loss in bipolar coagulation group and synchronous water-cooling bipolar coagulation group was significantly lower than that in suture hemostasis group(P<0.05).The length of hospital stay in synchronous water-cooling bipolar coagulation group was significantly lower than that in suture hemostasis group and bipolar coagulation group(P<0.05).There was no statistically significant difference between postoperative and preoperative AMH and AFC in suture hemostasis group and synchronous water-cooling bipolar coagulation group(P>0.05).There was no significant difference in AMH and AFC of T3 and T6 between suture hemostasis group and synchronous water-cooling bipolar coagulation group(P>0.05).The postoperative AMH and AFC of T3 and T6 in bipolar coagulation group were significantly lower than those in suture hemostasis group and synchronous water-cooling bipolar coagulation group(P<0.05).Conclusion Synchronous water-cooling bipolar coagulation during LOC benefits the protection of ovarian reserve and reduces intraoperative blood loss.