腹腔镜下卵巢囊肿手术不同止血方法对卵巢功能的影响

摘要

目的：探讨腹腔镜下卵巢囊肿剥除手术电凝和缝合两种止血方法对卵巢功能的影响。方法因双侧卵巢囊肿行腹腔镜下卵巢囊肿剥除术的40例患者随机分为2组，术中创面止血采用缝合法或电凝法，缝合组20例，电凝组20例。于术前、术后1个月及术后6个月月经期第3天上午抽血，利用放免法检测血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）及抗苗勒管激素（AMH），并行阴道超声检查，测卵巢大小、卵巢间质动脉血流的收缩期峰值（PSV）、窦卵泡数（AFC），以评判手术对卵巢储备功能的影响。结果2组术前一般情况和卵巢储备功能差异无统计学意义（ P＞0．05）。2组术后卵巢功能评价：缝合组术后1、6个月E2、AMH稍有下降， FSH稍升高，但与术前相比差异均无统计学意义（P＞0．05）；电凝组术后1、6个月E2、AMH明显下降，FSH明显升高，与术前相比差异均有统计学意义（P＜0．05）；术后1个月和6个月组间比较，E2、FSH、AMH差异均有统计学意义（P＜0．05），各组术前术后LH差异无统计学意义。缝合组术前与术后各时期卵巢AFC和PSV比较，差异均无统计学意义（P＜0．05）；电凝组术后1、6个月与术前比较AFC、PSV差异均有统计学意义（P＜0．05）；术后1、6个月组间比较，AFC、PSV 差异均有统计学意义（ P＜0．05）。各组术后卵巢大小差异无统计学意义。结论腹腔镜下卵巢囊肿剔除术中用电凝法进行卵巢创面的电凝止血，可影响术后卵巢储备功能，术中应尽量减少使用电凝止血，采用缝合法进行卵巢创面的止血整形。%Objective To evaluate the effects of suture and electrocoagulation for hemostasis on ovary reserve after laparoscopic ovary cystectomy .Methods Totally 40 patients who underwent laparoscopic cystectomy due to bilateral o-varian cysts were randomly divided into a suture group and an electrocoagulation group (20 in each), according to the he-mostatic method adopted during the operation .Blood samples were collected to examine the levels of serum follicle stimu-lating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-mullerian hormone (AMH) before operation, and on the third day's morning of the first menstrual cycle one/six months after operation .Meanwhile , transvaginal ultra-sound was carried out to measure the size of the ovary , PSV and AFC so as to evaluate ovarian reserve .Results Before operation, no significant differences were found in general condition and ovarian reserve between the two groups ( P<0.05).On the one hand, the suture group displayed slightly lower levels of E 2 and AMH together with a bit higher level of FSH one and six months after operation , which however were not statistically different from the corresponding preopera -tive levels (P>0.05).The electrocoagulation group presented remarkable reduction in E 2 and AMH but obvious rising in FSH one and six months after operation , indicating statistically difference from the corresponding preoperative levels (P<0.05).Significant differences existed in E2, FSH and AMH of each group one/six months after operation (P>0.05).The preoperative level of LH was not statistically different from its corresponding level after operation .On the other hand , for the suture group , its pro-operative levels of AFC and PSV did not remarkably changed when compared with the preoperative levels (P>0.05).For the electrocoagulation group, statistical differences were found in AFC and PSV before and one/six months after operation (P<0.05).Significant differences also existed in AFC and PSV of each group one/six months after operation (P<0.05).The preoperative size of the ovary was not statistically different from its corresponding preoperative value .Conclusion The application of electrocoagulation in laparoscopic ovarian cystectomy may affect ovarian reserve , which is suggested to be replaced by suture for hemostasis .