电凝止血和缝合止血对腹腔镜卵巢成熟畸胎瘤剥除术患者卵巢储备功能影响观察

摘要

目的:比较腹腔镜卵巢成熟畸胎瘤剥除术中电凝止血和缝合止血对患者卵巢储备功能的影响.方法:选取2014年5月-2016年5月本院收治的80例行腹腔镜下卵巢畸胎瘤剔除术患者,将其按照随机数字法随机分为电凝止血组和缝合止血组各40例,其中电凝止血组使用双极电凝止血方法,缝合止血组使用缝合止血的方法,分别记录两组手术时间及术中出血量,并检测术前末次月经的第3天时、术后3天及术后1、6个月的月经第3天时外周血雌二醇(E2)、促卵泡激素(FSH)、黄体生成素(LH)及抗苗勒管激素(AMH),并在术前及术后1、6个月抽血当天行经阴道超声记录窦卵泡数(F0)、卵巢体积及患侧卵巢间质血流峰值(PSV).结果:两组手术时间和术中出血量比较差异无统计学意义(均P＞o.o5).术后3天、1个月、6个月的E2及AMH水平均低予术前,但缝合止血组高于电凝止血组(均P＜0.05);FSH水平均高于术前,缝合止血组低于电凝止血组(均P＜0.05);LH水平均高于术前(均P＜0.05),但两组相比差异无统计学意义(均P＞0.05).两组患者术后1个月、6个月时的F0均低于术前,缝合止血组高于电凝止血组(均P＜0.05);卵巢体积及PSV缝合止血组较术前稍微回升,电凝止血组持续下降,缝合止血组高于电凝止血组(均P＜0.05).结论:腹腔镜成熟畸胎瘤剥除术中采用缝合止血的方法较电凝止血法更有利于卵巢储备功能的保护和卵巢储备功能术后恢复.%Objective:To compare the influence of electrocoagulation hemostasis with suture hemostasis on ovarian reserve function when patients undergoing laparoscopic ovarian maturity teratoma excision.Methods:From May 2014 to May 2016,80 patients experienced laparoscopic ovarian maturity teratoma excision were selected and randomly divided into the electrocoagulation group and the suture hemostasis group (40 cases in each group).Patients in electric coagulation group were given bipolar electrocoagulation hemostasis,and patients in suture group were given suture hemostasis.The amount of bleeding and the operation time were recorded for all patients.The estradiol (E2),follicle stimulating hormone (FSH),luteinizing hormone (LH) and anti mullerian hormone (AMH) of patients had been detected at the third day of the last menstrual period before surgery,postoperative and menstrual cycle postoperative 1 and 6 months.The number of antral follicles,ovarian volume and ipsilateral ovarian stromal blood flow peak (PSV) of patients were also monitored by transvaginal ultrasound (F0) at the third day of menstrual cycle postoperative 1 and 6 months.Results:There were no significant differences in operation time and blood loss between the two groups (P＞0.05).E2 and AMH of patients in both groups at postoperative3 days,1 months and 6 months were lower than those of patients before operation (P＜0.05),and E2,AMH of patients in suture group at postoperative 3 days,1 months and 6 months were significantly higher than those of patients in electrocoagulation group (P＜0.05).FSH level of patients after operation in both groups were higher than that of patients before operation (P＜0.05),and FSH level of postoperative patients in suture group were significantly lower than that of patients in electrocoagulation group (P＜0.05).LH level of patients after operation in both groups were higher than that of patients before operation (P＜0.05),hut there was no significant different for LH level of postoperative patients between suture group and electrocoagulation group (P＞0.05).FO of patients at postoperative1 months and 6 months in both groups were lower than that of patients before operation (P＜0.05),and FO of postoperative patients in suture group were significantly higher than that of patients in electrocoagulation group (P＜0.05).Ovarian volume and PSV of postoperative patients in suture group were bigger than those of patients before operation,but ovarian volume and PSV of postoperative patients in electrocoagulation group became smaller after operation.Ovarian volume and PSV of patients in suture group was bigger than those of patients in electrocoagulation group (P＜0.05).Conclusion:Suture hemostasis using in laparoscopic ovarian maturity teratoma excisioncan is in favor of protecting ovarian reserve function,and can improve the postoperative recovery of ovarian function.