腹腔镜下卵巢子宫内膜异位囊肿剔除术中3种止血方式对术后卵巢功能的影响

Effects of three hemostatic methods of electrocoagulation,suturing and oppression on ovarian function after laparoscopic ovarian endometriosis cystectomy

目的探讨腹腔镜下卵巢子宫内膜异位囊肿剔除术中电凝、缝合、压迫3种止血方式对术后卵巢功能的影响。方法选择建德市第一人民医院妇产科2011年1月—2016年12月腹腔镜下卵巢子宫内膜异位囊肿剔除术患者210例,根据随机数字法分为压迫组(压迫止血)、缝合组(缝合止血)、电凝组(电凝止血)。测定术前、术后月经周期第2~4天雌二醇(estradiol,E2)、睾酮(testosterone,T)、卵泡刺激素(follicle stimulating hormone,FSH)、促黄体生成素(luteinizing hormone,LH)水平及卵泡个数,月经第21天测定孕酮(progesterone,P)水平。结果压迫组和缝合组,术后1个月E2水平低于术前和术后6个月(P<0.05),FSH和LH水平高于术前和术后6个月(P<0.05),术后6个月E2、FSH、LH水平和术前比较差异无统计学意义(P>0.05);电凝组,术后1个月和术后6个月E2水平低于术前(P<0.05),FSH和LH水平高于术前(P<0.05),术后6个月E2水平低于术前(P<0.05),FSH、LH水平高于术前(P<0.05)。电凝组卵巢早衰率高于压迫组(P<0.05)。压迫组和对照组,术后1个月卵泡个数少于术前(P<0.05),术后6个月卵泡个数和术前比较差异无统计学意义(P>0.05),高于术后1个月(P<0.05);电凝组,术后1个月和术后6个月卵泡个数低于术前(P<0.05),术后6个月卵泡个数高于术后1个月(P<0.05);术后1个月和术后6个月,电凝组卵泡个数低于压迫组和缝合组(P<0.05)。结论腹腔镜下卵巢子宫内膜异位囊肿术中压迫止血对卵巢功能影响最小,缝合止血对卵巢功能影响和压迫止血相当,电凝止血对卵巢功能影响最大。

Objective To investigate the effect of three kinds of hemostatic methods of electrocoagulation,suturing and oppression on the ovarian function after laparoscopic ovarian endometriosis cysts. Methods Two hundred and ten cases patients of laparoscopic ovarian endometriosis cystectomy in the First People's Hospital of Jiande City from January,2011 to December,2016 were selected,and were divided into compression group( pressure to stop bleeding),suture group( suture hemostasis) and electrocoagulation group( coagulation hemostasis). The levels of E2,T,FSH,LH and the number of follicles were measured before and after surgery at menstrual cycle 2-4 days. The levels of P was measured before surgery,1 month after surgery and 6 months after surgery at menstrual cycle 21 days. Results In compression group and suture group,the level of E2 at postoperative 1 month was lower than that in preoperative and postoperative 6 months( P < 0. 05),the FSH and LH levels were higher than those preoperative and 6 months after operation( P < 0. 05),there was no significant difference in E2,FSH and LH between the two groups at 6 months after operation( P > 0. 05). In electrocoagulation group,the levels of E2 at 1 month and 6 months after operation were lower than those before operation( P < 0. 05),the FSH and LH levels at 1 month and 6 months after operation were higher than those before operation( P < 0. 05),the level of E2 at 6 months after operation was lower than that before operation( P < 0. 05),the FSH and LH levels at 6 months after operation were higher than those before operation( P < 0. 05). The premature ovarian failure rate of electrocoagulation group was higher than that of compression group( P < 0. 05). In compression group and control group,the number of follicles at 1 months after operation was less than that before operation( P < 0. 05),there was no significant difference in the number of follicles between 1 months after operation and 6 months after operation( P > 0. 05),and was higher than 1 month after operation( P < 0. 05). In electrocoagulation group,the number of follicles after 1 month and 6 months after operation were lower than that before operation( P < 0. 05),the number of follicles at 6 months after operation was higher than 1 months after operation( P < 0. 05). At1 month after surgery and 6 months after surgery,the number of follicles in electrocoagulation group was lower than that in compression group and suture group( P < 0. 05). Conclusion In laparoscopic ovarian endometriosis,the effect of press to stop bleeding on ovarian function is the least,the suture hemostasis on ovarian function is quite to oppression hemostasis,the electrocoagulation hemostasis has the greatest impact on ovarian function.