腹腔镜下卵巢囊肿蒂扭转复位手术对卵巢储备功能影响

摘要

[Objective]To investigate the effect of laparoscopic torsion reduction of ovarian cyst pedicle on ovarian re-serve function.[Methods]The clinical data of 80 patients with ovarian cyst pedicle torsion from January 2015 to July 2017 were analyzed retrospectively.Among them,40 cases were treated with laparoscopic reduction of ovarian cyst pedicle tor-sion(observation group),40 cases with laparoscopic appendectomy(control group).The perioperative indexes,indexes of ovarian reserve function [Estradiol(E2),follicle stimulating hormone(FSH),anti-Mullerian duct hormone(AM H), basic antral follicle count,peak systolic velocity of ovarian artery(PSV),end diastolic velocity(EDV),pulsatile index (Pi),resistance index(RI)]and the incidence of complications were compared between the two groups.[Results]The op-erative time and bleeding volume in the observation group were more than those in the control group,and the difference was statistically significant(P < 0.05),but there was no significant difference in the hospitalization time between the two groups(P >0.05).There was no significant difference in the indexes of ovarian reserve function between the two groups before operation(P >0.05).After operation,the E2,AFC,PSV,EDV in the observation group was significantly lower than that in the preoperative group.The decrease of E2in the observation group was significantly higher than that in the control group(P <0.05).The decrease rate of AFC,PSV,EDV in observation group was lower than that in control group(P <0.05),and the difference between the two groups was statistically significant(P <0.05).In both groups, the FSH,AMH,RI,PI were higher than those of preoperation.The increase of FSH in the observation group was higher than that in the control group(P <0.05),and the increase rate of AM H,RI,PI in the observation group was lower than that in the control group,the difference was statistically significant(P <0.05).There were no complications such as biliary tract injury,subcutaneous emphysema,hypercapnia in the two groups.[Conclusion]Laparoscopic transposition of ovarian cyst pedicle can preserve the attachment,which has little effect on the ovarian reserve function after operation, and has high safety,so it is worth popularizing in clinic.%[目的]探讨腹腔镜下卵巢囊肿蒂扭转复位手术对卵巢储备功能影响.[方法]回顾性分析2015年1月至2017年7月本院诊治的80例卵巢囊肿蒂扭转患者的临床资料,其中腹腔镜下卵巢囊肿蒂扭转复位术患者40例(观察组),腹腔镜下附件切除术40例(对照组),比较两组围术期指标、卵巢储备功能指标[雌二醇(E2)、促卵泡刺激素(FSH)、抗苗勒氏管激素(AM H);基础窦卵泡数(AFC)、卵巢动脉收缩期峰值流速(PSV)、舒张末期低值流速(EDV)、搏动指数(PI)、阻力指数(RI)]及并发症发生率.[结果]观察组手术时间及出血量均多于对照组,其差异有统计学意义(P <0.05),而两组住院时间比较差异无统计学意义(P >0.05).两组术前卵巢储备功能各指标比较差异无统计学意义(P >0.05);术后,观察组E2、AFC、PSV、EDV均较术前下降,观察组E2下降程度明显高于对照组,AFC、PSV、EDV 下降速度低于对照组,两组比较差异有统计学意义(P < 0.05);两组 FSH、AM H、RI、PI均较术前上升,观察组FSH上升程度高于对照组,AM H、RI、PI上升速度低于对照组,其差异均统计学意义(P <0.05).两组均未发生胆道损伤、皮下气肿、高碳酸血症等并发症.[结论]腹腔镜下卵巢囊肿蒂扭转复位手术能保留附件,对患者术后卵巢储备功能影响较小,且安全性高,值得临床推广应用.