腹腔镜卵巢子宫内膜异位囊肿剥除术中不同止血方法对卵巢储备功能的影响

摘要

Objective:To investigate the impact on ovarian reserve function with two different homostatic methods during laparoscopic cystectomy in treatment of endometrioma.Methods:Eighty four cases with unilateral ovarian cysts which located outside of hilum of ovary undergoing laparoscopic surgery were enrolled in the study. Based on hemostasis method, all patients were divided into 2 groups. Study group included 40 cases in ultrasonic scalpel hemostasis. Control group included 44 cases with suture after excision of endometrioma. Before surgery and the 1st, 3rd cycle after surgery, serum FSH, LH and AMH, and ultrasound basal AFC and PSV were examined and compared.Results: The level of FSH, LH, AMH, AFC and PSV had significant difference between before surgery and after surgery 1st, 3rd. The level of FSH, LH, AMH, AFC and PSV had significant difference within group comparisons after surgery 1st, 3rd. The level of serum FSH and LH in study group were lower than these in control group after surgery 1st. The level of serum AMH in study group were higher than in control group after surgery 3st. The level of serum PSV in study group were higher than in control group after surgery 3st.Conclusion: Ovarian reserve function was decresed heavier in ultrasonic scalpel hemostasis during laparoscopic excision of ovarian endometrioma than in suture. Electrocoagulation of the ovarian tissue should be avoided.%目的：探讨腹腔镜卵巢子宫内膜异位囊肿剥除术中，不同止血方法对卵巢储备功能的影响。方法：选择84例单侧卵巢子宫内膜异位囊肿的非卵巢门位患者，按照术中不同止血方式将其分为观察组和对照组。观察组40例，采用缝合法止血；对照组44例，采用超声刀止血。并分别于术前、术后第1个月、第3个月进行血清促卵泡激素(FSH)、黄体生成素(LH)及抗苗勒管激素(AMH)水平测定，以及超声测量卵巢基础窦卵泡计数(AFC)、卵巢基底动脉血流收缩期峰值(PSV)。结果：两组患者术前与术后比较，FSH、LH、AMH水平及AFC、PSV均差异显著；术后第1个月观察组FSH、LH水平均低于对照组；术后第3个月观察组AMH高于对照组；术后第3个月观察组PSV大于对照组。结论：应用超声刀止血对卵巢储备功能损伤的近期效应高于缝合法，临床应谨慎使用电凝烧灼方式止血。