腹腔镜囊肿剥除术中缝合止血对卵巢功能的保护效果

Effect of suture hemostasis in laparoscopic cyst stripping on the protection of ovarian function

目的:观察腹腔镜卵巢囊肿剥除术中采用缝合止血对卵巢良性囊肿患者卵巢功能的保护效果。方法:将80例卵巢良性囊肿患者按照随机数字表法分为对照组与观察组,每组40例。两组均行腹腔镜卵巢囊肿剥除术,对照组术中采用双极电凝止血,观察组予以缝合止血。对比两组术中出血量、术后月经恢复情况、排气时间、卵巢功能指标(窦卵泡数量、卵巢最大直径、雌二醇、卵泡刺激素、黄体生成素)、免疫状态指标(T细胞亚群)、妊娠结局。结果:术后6个月,观察组月经复常率高于对照组[87.5%(35/40)vs.65.0%(26/40),P<0.05],观察组窦卵泡数量多于对照组,卵巢最大直径大于对照组(P<0.05),观察组性激素水平与术前相比差异无统计学意义(P>0.05),观察组雌二醇水平高于对照组,卵泡刺激素、黄体生成素水平低于对照组(P<0.05)。术后3个月,观察组CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组(P<0.05)。术后随访两年,观察组足月产率高于对照组[70.0%(28/40)vs.40.0%(16/40),P<0.05]。结论:腹腔镜卵巢囊肿剥除术中采用缝合止血对卵巢良性囊肿患者卵巢功能的保护效果更好,更利于减轻免疫抑制,提高术后足月产率,改善妊娠结局。

Objective:To observe the effect of suturing hemostasis during laparoscopic ovarian cyst stripping on postoperative o varian function protection in patients with benign ovarian cyst.Methods:Eighty patients with benign ovarian cyst were selected and d ivided into a control group and an observation group according to the random number table method,with 40 cases in each group.Patients in the two groups underwent laparoscopic ovarian cyst removal.The control group was given bipolar electrocoagulation during the operation,and the observation group was given suture hemostasis.Intraoperative blood loss,postoperative menstrual recovery,exhaust time,ovarian function indicators(antral follicle count,maximum ovarian diameter,estradiol,follicle stimulating hormone,luteinizing hormone),immune status indicators(T cell subgroup)and pregnancy outcome were compared between the two groups.Results:Six months after operation,the rate of menstrual normalization in the observation group was 87.5%(35/40),which was significantly higher than 65.0%(26/40)in the control group(P<0.05).The antral follicle count in the observation group was significantly higher than that in the control group,and the maximum ovarian diameter was significantly higher than the control group(P<0.05).There was no significant difference in the sex hormone levels of the observation group 6 months after surgery compared with those before surgery(P>0.05).The estradiol level of the observation group was significantly higher than that of the control group,while the follicle stimulating hormone and luteinizing hormone levels were significantly lower than those of the control group(P<0.05).Three months after o peration,CD4^(+)and CD4^(+)/CD8^(+)in the observation group were significantly higher than those in the control group,while CD8^(+)was s ignificantly lower than that in the control group(P<0.05).During the follow-up of 2 years,the full-term birth rate of the observation group was 70.0%(28/40),which was significantly higher than 40.0%(16/40)of the control group(P<0.05).Conclusions:Suture hemostasis in laparoscopic cyst stripping has a better protective effect on ovarian function in patients with benign ovarian cyst,it is more conducive to reducing immune suppression,increasing postoperative full term birth rate and improving pregnancy outcome.