腹腔镜下不同解剖位置卵巢囊肿剥除术后应用双极电凝和缝合止血对卵巢功能及妊娠影响

Effects of bipolar electrocoagulation and suture for hemostasis during laparoscopic ovarian cystectomy of patients with different anatomical positions of ovarian cyst on the ovarian reserve function and pregnancyof the patien

目的:分析腹腔镜下不同解剖位置卵巢囊肿剥除术后应用双极电凝和缝合止血对卵巢储备功能和妊娠的影响。方法:选择2020年3月—2021年3月本院收治的卵巢囊肿患者124例,随机数字表法分为电凝组(双极电凝止血)和缝合组(缝合止血)各62例。于术前、术后3个月检测患者月经第3d时性激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)]水平和抗苗勒试管激素(AMH)水平,同时行阴道超声检查患者双侧卵巢窦卵泡数量,术后随访12个月患者妊娠情况。结果:卵巢门近端囊肿患者中,术后3个月电凝组FSH、LH水平高于术前,E_2、AMH水平低于术前,双侧卵巢窦卵泡数量少于术前(均P<0.05);缝合组各指标与术前比较无差异(P>0.05),且FSH、LH水平低于电凝组,E_2、AMH水平高于电凝组,双侧卵巢窦卵泡数量少于缝合组(均P<0.05)。术前及术后3个月,电凝组和缝合组卵巢门远端囊肿患者性激素水平、AMH及双侧卵巢窦卵泡数量无差异,卵巢门近端及远端囊肿患者不良妊娠结局无差异(P>0.05)。结论:对卵巢门近端囊肿患者,腹腔镜下卵巢囊肿剥除术后应用缝合止血更有助于保护患者卵巢功能,对卵巢门远端囊肿患者则建议首选双极电凝止血。腹腔镜下不同解剖位置卵巢囊肿剥除术后应用双极电凝和缝合止血对患者不良妊娠结局未见影响。

Objective:To analyze the effects of bipolar electrocoagulation and suture for hemostasis during laparoscopic ovarian cystectomy of patients with different anatomical positions of ovarian cyst on the ovarian reserve function and pregnancy of the patients.Methods:124patients with ovarian cysts who wanted laparoscopic ovarian cystectomy were selected and were randomly divided into group A(62patients with bipolar electrocoagulation hemostasis during surgery)and group B(62patients with suture hemostasis during surgery)according to the random number table method from March 2020to March 2021.The levels of sex hormones,such as follicle stimulating hormone(FSH),luteinizing hormone(LH),and estradiol(E2),and the anti-Mullerian hormone(AMH)level of the patients in the two groups on the 3rd day of menstruation before surgery and in 3months after surgery were detected.The vaginal ultrasound examination was performed to measure the number of bilateral ovarian antral follicles of the patients in the two groups.In the 12th month after surgery,the pregnancy statuses of the patients in the two groups were followed up.Results:The FSH and LH levels of the patients with proximal hilar cyst in group A in the 3rd month after surgery were significantly higher than before surgery,but the E2and AMH levels,and the number of follicles in bilateral ovarian were significantly lower than those of the patients before surgery(all P<0.05).There were no significant differences in the FSH and LH levels,and the number of follicles in bilateral ovarian of the patients with proximal hilar cyst in group B compared between before and after surgery(P>0.05).The levels of FSH and LH,and the number of follicles in bilateral ovarian of the patients in group B were significantly lower than those of the patients in group A,but the levels of E2and AMH of the patients in group B were significantly higher(all P<0.05).There were no significant differences in the levels of the sex hormones and AMH,and the number of follicles in bilateral ovarian of the patients with distal ovarian hilar cyst before surgery and 3months after surgery between the two groups.There were no significant differences in the adverse pregnancy outcomes between the patients with proximal ovarian hilar cyst and the patients with distal ovarian hilar cyst(P>0.05).Conclusion:For the patients with proximal ovarian hilar cysts,the suture hemostasis during laparoscopic ovarian cystectomy is more helpful to protect the ovarian function when comparing with those of the bipolar electrocoagulation hemostasis,but for the patients with distal ovarian hilar cysts,bipolar electrocoagulation hemostasis is recommended as the preferred choice.The bipolar electrocoagulation and suture for hemostasis during laparoscopic ovarian cystectomy of the patients with different anatomical locations of the ovarian cysts all have no adverse influence on the pregnancy outcomes of the patients.