不同缝合方法对腹腔镜下卵巢囊肿剥除术患者残留卵巢储备功能的影响比较

Comparison of the effects of different suture methods on residual ovarian reserve function in patients undergoing laparoscopic ovarian cystectomy

目的比较不同缝合方法对腹腔镜下卵巢囊肿剥除术患者残留卵巢储备功能的影响。方法选择2017年4月至2019年10月广西壮族自治区人民医院收治的卵巢子宫内膜异位囊肿患者120例,采用随机数字表法将其分为囊内多点连续缝合法组(A组)、基底部连续U型缝合法组(B组)、囊外连续缝合法组(C组)、囊外间断缝合法组(D组),每组30例。比较四组的手术时间和术中出血量,以及术前(T_(1))、术后1个月(T_(2))、术后3个月(T_(3))、术后6个月(T_(4))和术后1年(T_(5))的卵巢储备功能相关指标[包括血清雌二醇(E_(2))、孕激素(P)、卵泡刺激素(FSH)、黄体生成素(LH)、窦卵泡数(F0)、卵巢间质动脉血流的收缩期峰值流速(PSV)、舒张期低值流速(EDV)、阻力指数(RI)、搏动指数(PI)]。结果B组手术时间最短,术中出血量最少,与其他三组比较差异有统计学意义(P<0.05)。在T 2~T 5时间点,四组E_(2)、P、F0、PSV水平均呈先下降后升高的趋势,在T 3时间点达到最低值,B组E 2、P、F0、PSV水平较其他三组高,四组变化幅度差异有统计学意义(P<0.05)。四组FSH、LH、RI、PI水平呈先上升后降低的趋势,在T_(3)时间点达到最高值,B组FSH、LH、RI、PI水平较其他三组低,四组变化幅度差异有统计学意义(P<0.05)。结论腹腔镜下卵巢囊肿剥除术中采用基底部连续U型缝合法具有止血效果好、手术操作时间短,且患者术后卵巢储备功能恢复较快的优点。

Objective To compare the effects of different suture methods on residual ovarian reserve function in patients undergoing laparoscopic ovarian cystectomy.Methods One hundred and twenty patients with ovarian endometriosis cyst who were admitted to the People′s Hospital of Guangxi Zhuang Autonomous Region from April 2017 to October 2019 were selected and randomly divided into intracapsular multi-point continuous suture group(group A),base continuous U-shaped suture group(group B),extracapsular continuous suture group(group C),extracapsular interrupted suture group(group D),with 30 cases in each group.The operation time and intraoperative blood loss were compared among the four groups.The ovarian reserve function-related indicators[including serum estradiol(E_(2)),progesterone(P),follicle stimulating hormone(FSH),luteinizing hormone(LH),antral follicle count(F0),inter-ovarian peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI)and pulse index(PI)]were compared among the four groups before surgery(T_(1)),1 month after surgery(T_(2)),3 months after surgery(T_(3)),6 months after surgery(T_(4)),and 1 year after surgery(T 5).Results The operation time of the group B was the shortest,and its intraoperative blood loss was the least among the four groups,and the difference in the operation time and intraoperative blood loss were statistically significant between the group B and the other three groups(P<0.05).From T_(2)to T_(5)time points,the levels of E_(2),P,F0 and PSV in the four groups showed a decreasing trend first and then increased,reaching the lowest values at T_(3)time point.The levels of E_(2),P,F0 and PSV in the group B were higher than those in the other three groups,and the amplitude differences were statistically significant among the four groups(P<0.05).The levels of FSH,LH,RI,and PI in the four groups showed an increasing trend first and then decreased,reaching the highest values at T_(3)time point.The levels of FSH,LH,RI and PI in the group B were lower than those in the other three groups,and the amplitude differences were statistically significant among the four groups(P<0.05).Conclusion The base continuous U-shaped suture method has the advantages of good hemostatic effect,short operation time and quick recovery of ovarian reserve function after surgery in patients undergoing laparoscopic ovarian cystectomy.