开腹卵巢囊肿剥除术与气腹式腹腔镜卵巢囊肿剥除术对良性卵巢囊肿患者卵巢功能的影响比较

Comparison of the effect between abdominal oophorocystectomy and pneumoperitoneal laparoscopic oophorocystectomy on ovarian function in patients with benign ovarian cyst

目的比较开腹卵巢囊肿剥除术与气腹式腹腔镜卵巢囊肿剥除术治疗良性卵巢囊肿的临床效果及其对卵巢功能的影响。方法选择2016年1月至2017年12月郑州大学附属洛阳中心医院收治的71例良性卵巢囊肿患者为研究对象,根据手术方式将患者分为开腹手术组(28例)和腹腔镜手术组(43例)。开腹手术组患者行开腹卵巢囊肿剥除术,腹腔镜手术组患者行气腹式腹腔镜卵巢囊肿剥除术。记录2组患者的手术时间、术中出血量、术后肛门排气时间及术后并发症;分别于术前及术后1、3、12个月采用放射免疫分析法检测2组患者血清促卵泡激素(FSH)、雌二醇(E2)及促黄体激素(LH)水平。结果与开腹手术组比较,腹腔镜手术组患者手术时间长,术后肛门排气时间短,术中出血量少(P<0.05)。开腹手术组和腹腔镜手术组患者术后并发症发生率分别为25.00%(7/28)、13.95%(6/43),腹腔镜手术组患者术后并发症发生率低于开腹手术组(χ~2=7.063,P<0.05)。2组患者术前血清FSH、E2及LH水平比较差异均无统计学意义(P>0.05)。开腹手术组患者术后1、3、12个月时血清FSH、LH水平高于术前,E2水平低于术前(P<0.05)。腹腔镜手术组患者术后1、3个月时血清FSH、LH水平高于术前,E2水平低于术前(P<0.05);腹腔镜手术组患者术后12个月与术前血清FSH、E2及LH水平比较差异无统计学意义(P>0.05)。术后1、3、12个月,腹腔镜手术组患者血清FSH、LH水平低于开腹手术组,E2水平高于开腹手术组(P<0.05)。结论开腹卵巢囊肿剥除术创伤大,对患者术后卵巢功能影响较严重;气腹式腹腔镜卵巢囊肿剥除术创伤小,对患者术后卵巢功能影响较小,且并发症发生率低。

Objective To compare the effect between abdominal oophorocystectomy and pneumoperitoneal laparoscopic oophorocystectomy on ovarian function in patients with benign ovarian cyst.Methods A total of 71 patients with benign ovarian cyst admitted to Luoyang Central Hospital Affiliated to Zhengzhou University from January 2016 to December 2017 were selected as the research objects,and the patients were divided into laparotomy group(n=28)and laparoscopic operation group(n=43)according to the operation mode.The patients in the laparotomy group were treated with abdominal oophorocystectomy,while the patients in the laparoscopic operation group were treated with pneumoperitoneal laparoscopic oophorocystectomy.The operation time,intraoperative bleeding volume,postoperative anal exhaust time and postoperative complications of patients in the two groups were recorded.The levels of serum follicle stimulating hormone(FSH),estradiol(E2)and luteinizing hormone(LH)were detected by radioimmunoassay before operation and 1,3,12 months after operation.Results The operation time in the laparoscopic operation group was longer than that in the laparotomy group,the postoperative anal exhaust time was shorter than that in the laparotomy group,and the intraoperative bleeding volume was less than that in the laparotomy group(P<0.05).The incidence of postoperative complications in the laparotomy group and laparoscopic operation group was 25.00%(7/28)and 13.95%(6/43),respectively.The incidence of postoperative complications in the laparoscopic operation group was lower than that in the laparotomy group(χ~2=7.063,P<0.05).There was no significant difference in the levels of serum FSH,E2 and LH between the two groups before operation(P>0.05).The levels of serum FSH and LH were higher and the level of serum E2 was lower at 1,3 and 12 months after operation than those before operation in the laparotomy group(P<0.05).The levels of serum FSH and LH were higher and the level of serum E2 was lower at 1 and 3 months after operation than those before operation in the laparoscopic operation group(P<0.05).There was no significant difference in the levels of serum FSH,E2 and LH between 12 months after operation and before operation in the laparoscopic operation group(P>0.05).The levels of serum FSH and LH in the laparoscopic operation group were lower than those in the laparotomy group,and the level of serum E2 was higher than that in the laparotomy group at 1,3 and 12 months after operation(P<0.05).Conclusion The abdominal oophorocystectomy has greater trauma,which has more serious impact on ovarian function after operation.The pneumoperitoneal laparoscopic oophorocystectomy has less trauma,less impact on ovarian function and lower incidence of complications.