Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma

摘要

Objective To evaluate the impact of different hemostasis methods on ovarian reserve in laparoscopic cystectomy in treatment of ovarian endometrioma for the long-term. Materials and Methods A total of 207 patients with ovarian endometrioma, aged from 18?years to 45?years, were randomized into three groups: Group A (69 patients) treated by bipolar electrocoagulation hemostasis in laparoscopic cystectomy for ovarian endometrioma; Group B (69 patients) with ultrasound scalpel hemostasis; and Group C (69 patients) with suture technique hemostasis. The follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC), and peak systolic velocity (PSV) were observed and compared at the 3 rd day of the 1 st , 3 rd , 6 th , and 12 th menstrual cycle after surgery. Results (1) A total of 13 out of 207 patients failed; four in Group A, five in Group B, and four in Group C. There was no statistically significant difference between groups ( p ??0.05). The failure rate was the highest during the 3 rd month in the follow up (10 cases). (2) FSH: at the 1 st month, 3 rd month, 6 th month, and 12 th month follow up, FSH was higher in Group A and Group B than in Group C ( p ??0.05). (3) AMH: AMH was significantly lower in Group A and Group B than in Group C ( p ??0.05) during the same period. (4) AFC: no difference of AFC was observed at the 1 st month and 3 rd month ( p ??0.05), whereas at the 6 th month and 12 th month, AFC in Group C was obviously higher than that in Group A and Group B ( p ??0.05). (5) PSV: at the 1 st month, 3 rd month, 6 th month, and 12 th month follow up, PSV was significantly lower in Group A and in Group B than in Group C ( p ??0.05). Conclusion Ultrasonic scalpel or bipolar electrocoagulation hemostasis applied to laparoscopic cystectomy is associated with a significant reduction of ovarian reserve. Electrocoagulation of hemostasis should be used with caution.