不同术式对卵巢子宫内膜异位囊肿患者预后的影响

Effect of Different Surgical Methods on Prognosis of Patients with Ovarian Endometriosis Cyst

目的分析不同术式对卵巢子宫内膜异位囊肿(OEC)患者预后的影响。方法选择2018年11月至2020年11月无锡市妇幼保健院收治的拟行OEC手术治疗的100例患者为研究对象,根据不同手术方式分为冷刀组(50例)和电凝组(50例),均于月经干净后3~5 d行腹腔镜下卵巢囊肿剥除术,冷刀组患者术中全程使用冷刀剥除、不使用电设备,电凝组患者术中使用双极电凝、不缝合。观察两组患者手术情况,手术前后窦卵泡计数(AFC)、卵巢体积、激素[抗米勒管激素(AMH)、雌二醇(E_(2))、黄体生成素(LH)、卵泡刺激素(FSH)]分泌水平以及术后切口感染、出血等并发症发生情况。结果冷刀组患者术中出血量多于电凝组、手术时间长于电凝组[(95±10)ml比(90±9)ml、(85.1±13.5)min比(78.8±12.7)min](P<0.05)。AFC组间、时点间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.05);卵巢体积时点间的主效应差异有统计学意义(P<0.01),组间的主效应差异无统计学意义(P>0.05),组间和时点间无交互作用(P>0.05);术后6、12个月,冷刀组患者AFC明显多于电凝组(P<0.05),而卵巢体积无明显差异(P>0.05)。AMH、E_(2)、LH、FSH时点间和组间的主效应差异有统计学意义(P<0.05或P<0.01),AMH组间和时点间无交互作用(P>0.05),E_(2)、LH、FSH组间和时点间存在交互作用(P<0.01);术后6、12个月,冷刀组患者AMH、E_(2)水平明显高于电凝组,LH、FSH水平明显低于电凝组(P<0.05)。两组患者术后切口感染、出血、发热、复发的发生率比较差异均无统计学意义(P>0.05)。结论OEC腹腔镜下卵巢囊肿剥除术中,与使用双极电凝相比,全程采用冷刀剥除能够更好地保护卵巢储备功能,术后患者卵巢储备功能指标更佳,优势更明显。

Objective To analyze the effect of different surgical methods on the prognosis of patients with ovarian endometriosis cyst(OEC).Methods A total of 100 patients who planned to undergo OEC surgery in Wuxi Maternal and Child Health Hospital from Nov.2018 to Nov.2020 were included.According to different surgical methods,they were divided into a cold knife group(50 cases)and an electrocoagulation group(50 cases).Laparoscopic ovarian cyst excision was performed 3-5 days after menstruation.In the cold-knife group,cold knife was used throughout the operation without electrical equipment,while in the electrocoagulation group,bipolar electrocoagulation was used without suture.The surgical situation,antral follicle count(AFC)before and after surgery,ovarian volume,hormone secretion level[anti-Müllerian hormone(AMH),estradiol(E_(2)),luteinizing hormone(LH),follicle-stimulating hormone(FSH)],postoperative incision infection,bleeding and other complications were observed in the two groups.Results The intraoperative blood loss in the cold knife group was higher than that in the electrocoagulation group,and the operative time was longer than that in the electrocoagulation group[(95±10)ml vs(90±9)ml,(85.1±13.5)min vs(78.8±12.7)min](P<0.05).The main effect difference of AFC was statistically significant between groups and time points(P<0.01),and there was interaction between groups and time points(P<0.05).The main effect difference of ovarian volume between time points was statistically significant(P<0.01),but was not statistically significant between groups(P>0.05),and there was no interaction between groups and time points(P>0.05).At 6 and 12 months after surgery,AFC in the cold knife group was significantly higher than that in the electrocoagulation group(P<0.05),but there was no significant difference in ovarian volume(P>0.05).The main effect differences of AMH,E_(2),LH and FSH were statistically significant between time points and between groups(P<0.05 or P<0.01).There was no interaction in AMH between groups and time points(P>0.05),but there were interactions in E_(2),LH and FSH between groups and time points(P<0.01).At 6 and 12 months after surgery,AMH and E_(2)levels in the cold knife group were significantly higher than those in the electrocoagulation group,while LH and FSH levels were significantly lower than those in the electrocoagulation group(P<0.05).There were no significant differences in the incidences of postoperative incision infection,bleeding,fever and recurrence between the two groups(P>0.05).Conclusion Compared with bipolar electrocoagulation,the whole process of laparoscopic OEC removal with cold knife can better protect the ovarian reserve function,with has better postoperative ovarian reserve function indexes,and shows more obvious advantages.