缝合止血与双极电凝止血在腹腔镜卵巢子宫内膜异位囊肿剥除术中的应用效果

Effect of suture hemostasis and bipolar electrocoagulation hemostasis in laparoscopic ovarian endometriosis cyst removal

目的比较缝合止血与双极电凝止血在腹腔镜卵巢子宫内膜异位囊肿(OEMC)剥除术中的应用效果,为止血方案的选择提供更多参考依据。方法选取2020年1月至2021年12月该院收治的120例OEMC患者作为研究对象,均行腹腔镜OEMC剥除术治疗,根据术中止血方式不同分为缝合组(缝合止血)和电凝组(双极电凝止血),每组各60例。缝合组术中中转开腹1例,电凝组因继续出血而转为缝合1例,术后失访1例。最终缝合组59例、电凝组58例纳入本研究。比较两组患者手术时间及术中出血量;比较两组患者术前、术后1个月、术后3个月时性激素[卵泡成熟激素(FSH)、黄体生成激素(LH)、雌二醇(E_(2))、抗苗勒氏管激素(AMH)]水平及卵巢储备功能[窦卵泡计数(AFC)、卵巢间质血流峰值(PSV)];术后随访6个月,记录所有患者卵巢储备功能下降情况。结果电凝组患者手术时间明显短于缝合组,术中出血量少于缝合组,差异均有统计学意义(P<0.05);两组患者术后1个月FSH、LH水平均升高,而E_(2)、AMH水平均下降,而术后3个月FSH、LH水平均呈下降趋势,E_(2)、AMH水平均呈上升趋势,且缝合组变化更明显,差异均有统计学意义(P<0.05);两组患者术后1个月AFC、PSV均下降,术后3个月AFC、PSV均呈上升趋势,且缝合组变化更明显,差异均有统计学意义(P<0.05);术后随访6个月,两组患者卵巢储备功能下降率比较,差异无统计学意义(χ^(2)=0.277,P=0.599),所有患者均未出现卵巢功能早衰。结论电凝止血与缝合止血在腹腔镜OEMC剥除术中对患者近期卵巢功能均有一定影响,缝合止血对卵巢功能的影响较小,术后卵巢功能恢复更快,而电凝止血具有手术时间短、术中出血量少等优势。

Objective To compare the application effect of suture hemostasis and bipolar electrocoagulation hemostasis in laparoscopic ovarian endometrial cyst(OEMC)removal,so as to provide more reference for the selection of hemostasis scheme.Methods A total of 120 cases of OEMC patients admitted to the hospital from January 2020 to December 2021 were the subjects of this study.All patients were treated with laparoscopic OEMC stripping.They were divided into suture group(n=60,suture hemostasis)and electrocoagulation group(n=60,bipolar electrocoagulation hemostasis)according to different hemostasis methods during the operation.One case in suture group was converted to laparotomy during operation,one case in electrocoagulation group was converted to suture due to continuous bleeding,and one case lost follow-up after operation.A total of 59 patients in the final suture group and 58 patients in the electrocoagulation group entered the study.The operation time and intraoperative blood loss were compared between the two groups.The sex hormones[follicle maturation hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)),anti Mullerian hormone(AMH)],ovarian reserve function[sinus follicle count(AFC),peak ovarian interstitial blood flow(PSV)]were compared between the two groups before operation,one month after operation,and three months after operation.At the same time,the patients were followed up for 6 months to record the decline of ovarian reserve function.Results The operation time in the electrocoagulation group was significantly shorter than that in the suture group,and the intraoperative bleeding was less than that in the suture group(P<0.05).The levels of FSH and LH in both groups increased one month after surgery,while the levels of E2 and AMH decreased.However,the levels of FSH and LH showed a downward trend three months after surgery,while the levels of E2 and AMH showed an upward trend.The changes in the suture group were more significant,with significant differences(P<0.05).The AFC and PSV in both groups decreased 1 month after surgery,and increased 3 months after surgery.The changes in the suture group were more significant,with significant differences(P<0.05).After a follow-up of 6 months,there was no statistically significant difference in the rate of decline in ovarian reserve function between the two groups(χ^(2)=0.277,P=0.599),and no premature ovarian failure occurred.Conclusion Both electrocoagulation hemostasis and suture hemostasis have a certain impact on the short-term ovarian function of patients during laparoscopic OEMC stripping.Suture hemostasis has a small impact on ovarian function,and the ovarian function recovers faster after surgery.However,electrocoagulation hemostasis has the advantages of short operation time and less intraoperative bleeding.