腹腔镜下囊肿剔除术对卵巢囊肿患者卵巢功能、性激素及切口美观度的影响

Effect of laparoscopic cystectomy on ovarian function,sex hormones,and incision aesthetics in patients with ovarian cysts

目的 探讨腹腔镜下囊肿剔除术对卵巢囊肿患者卵巢功能、性激素及切口美观度的影响。方法 回顾性分析2017年6月至2019年6月陕西中医药大学第二附属医院妇科收治的96例卵巢囊肿患者的临床资料,根据治疗方案的不同分为对照组(传统开腹卵巢囊肿剥除术) 40例和观察组(腹腔镜卵巢囊肿剥除术) 56例,比较两组患者手术情况(手术时间、术中出血量、术后至下床时间及术后住院时间)、卵巢功能[抗苗勒管激素(AMH)]、性激素水平[雌二醇(E2)、促卵泡生成素(FSH)、促黄体生成素(LH)]及术后切口恢复美观度(切口愈合后瘢痕宽度、拆线时间、患者对愈合瘢痕外观的满意度)和并发症。结果 观察组患者术中出血量[(62.32±3.19) m L]较对照组[(125.37±5.76) mL]少,而手术所需时间[(62.04±1.50) min]、术后至下床时间[(8.69±0.79) h]以及术后住院时间[(4.98±0.21) d]均显著短于对照组患者[(75.87±2.54) min、(18.27±1.53) h、(8.56±0.76) d],差异具有统计意义(P<0.05);两组患者术后1个月和术后3个月AMH水平均较术前下降,但两组患者术前与术后1个月、术后3个月AMH比较差异无统计学意义(P>0.05);两组患者术后1个月E2较术前降低,FSH及LH水平均较术前升高,术后3个月E2较术后1个月升高,FSH及LH术后3个月均较术后1个月降低,差异均具有统计学意义(P<0.05),两组E2、FSH及LH水平术后3个月均逐渐恢复至正常;但两组E2、FSH及LH水平在术前、术后1个月及术后3个月比较差异均无统计学意义(P>0.05);观察组患者术后切口愈合后瘢痕宽度[(1.02±0.22) mm]显著小于对照组[(2.08±0.46) mm],拆线时间[(5.04±0.36) d]短于对照组[(8.86±1.09) d],且对于切口愈合后瘢痕外观满意度[(96.46±1.89)分]也较对照组[(81.42±1.36)分]显著升高(P<0.05);观察组患者术后并发症总发生率为3.57%,显著低于对照组患者的22.50%,差异具有统计学意义(P<0.05)。结论 腹腔镜手术治疗卵巢囊肿临床疗效与传统开腹手术类似,均可促进患者卵巢功能及性激素水平的恢复,但腹腔镜手术创伤更小,安全性更高,以及术后切口瘢痕外观美观度更易让患者满意,值得临床推广使用。

Objective To investigate the effect of laparoscopic cystectomy on ovarian function,sex hormones,and incision aesthetics in patients with ovarian cysts.Methods Ninety-six patients with ovarian cysts treated in the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from June 2017 to June 2019 were selected as research objects.According to different treatments,they were divided into control group(treated with traditional laparotomy of ovarian cystectomy,40 cases) and observation group(treated with laparoscopic ovarian cystectomy,56 cases).After treatment,the two groups were compared in surgical conditions(operation time,intraoperative blood loss,time from the end of operation to ambulation,and postoperative hospital stay),ovarian function [anti-Müllerian hormone(AMH)],sex hormone levels [estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH)],postoperative incision aesthetics(scar width after incision healing,removal time of suture,patients’ satisfaction with the appearance of the healed scar),and complications.Results The intraoperative blood loss was(62.32±3.19) m L in the observation group,significantly less than(125.37±5.76) m L in the control group,and operation time,time from the end of operation to ambulation,postoperative hospital stay were(62.04±1.50) min,(8.69±0.79) h,(4.98±0.21) d,significantly shorter than(75.87±2.54) min,(18.27±1.53) h,(8.56±0.76) d in the control group,with statistically significant differences(P0.05).In the two groups,E2 at 1 month after operation was lower than that before surgery,and FSH and LH levels were higher than those before surgery;E2 level at 3 months after surgery was higher than that at 1 month after surgery;FSH and LH at 3 months after operation were lower than those at 1 month after surgery;the differences were statistically significant(P0.05).The scar width after incision healing in the observation group was(1.02±0.22) mm,significantly smaller than(2.08±0.46) mm in the control group,and the removal time of suture was(5.04±0.36) d,significantly shorter than(8.86±1.09) d in the control group,with statistically significant differences(P<0.05).The patients’ satisfaction with the appearance of the healed scar was(96.46±1.89) points,significantly higher than(81.42±1.36) points in the control group(P<0.05).The total incidence of postoperative complications in the observation group was 3.57%,which was significantly higher than 22.50% in the control group(P<0.05).Conclusion The clinical efficacy of laparoscopic surgery in the treatment of ovarian cysts is similar to that of traditional laparotomy,and both can improve the recovery of ovarian function and sex hormone levels in patients.However,laparoscopic surgery brings smaller trauma,higher safety,and more satisfactory aesthetic appearance of healed scars.It is worthy of clinical popularization.