CAJ | 학술논문

目的探讨腹腔镜下卵巢子宫内膜异位囊肿剥除术中创面采用双极电凝及缝合两种止血方式对卵巢储备功能的影响。方法选择卵巢子宫内膜异位囊肿行腹腔镜手术治疗的患者60例，根据术中创面止血方式随机分为两组：镜下缝合组、双极电凝组，每组各30例。于术前、术后1、6个月月经周期的第2~3天，分别检测患者血清抗苗勒管激素（AMH）、卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）及阴道超声探测窦状卵泡数目（AFC）、患侧卵巢动脉收缩期峰值血流速度（PSV）为判断卵巢储备功能状态的指标。结果缝合组各项指标手术前后无显著差异（P>0.05）。电凝组术后E2、AMH水平及AFC、PSV与术前相比显著降低，术后FSH水平较术前显著升高（P<0.05）。两组患者LH水平手术前后无显著差异（P>0.05）。电凝组术后1个月及6个月E2、AMH水平及AFC、PSV较缝合组降低更明显， FSH水平与缝合组相比显著升高（P<0.05）。两组术后共发生卵巢储备功能下降6例（缝合组2例，电凝组4例）。结论腹腔镜下卵巢子宫内膜异位囊肿剥除术中不同的止血方式对卵巢储备功能的影响有差异，其中双极电凝止血法较镜下缝合止血法所致卵巢储备功能下降更加显著。
목적탐토복강경하란소자궁내막이위낭종박제술중창면채용쌍겁전응급봉합량충지혈방식대란소저비공능적영향。방법선택란소자궁내막이위낭종행복강경수술치료적환자60례，근거술중창면지혈방식수궤분위량조：경하봉합조、쌍겁전응조，매조각30례。우술전、술후1、6개월월경주기적제2~3천，분별검측환자혈청항묘륵관격소（AMH）、란포자격소（FSH）、황체생성소（LH）、자이순（E2）급음도초성탐측두상란포수목（AFC）、환측란소동맥수축기봉치혈류속도（PSV）위판단란소저비공능상태적지표。결과봉합조각항지표수술전후무현저차이（P>0.05）。전응조술후E2、AMH수평급AFC、PSV여술전상비현저강저，술후FSH수평교술전현저승고（P<0.05）。량조환자LH수평수술전후무현저차이（P>0.05）。전응조술후1개월급6개월E2、AMH수평급AFC、PSV교봉합조강저경명현， FSH수평여봉합조상비현저승고（P<0.05）。량조술후공발생란소저비공능하강6례（봉합조2례，전응조4례）。결론복강경하란소자궁내막이위낭종박제술중불동적지혈방식대란소저비공능적영향유차이，기중쌍겁전응지혈법교경하봉합지혈법소치란소저비공능하강경가현저。
Objective To investigate the effects of two different hemostatic methods (bipolar electrocoagulation and suture) on ovarian reserve function in patients with endometriosis. Methods Sixty patients who underwent laparoscopic surgical treatment for ovarian endometriosis cysts were divided into bipolar electrocoagulation group and sutured group (n=30 in each group). The average contents of anti-mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), antral follicle count (AFC), and peak systolic velocity (PSV) were compared in electrocoagulation group and suture group. Results For the sutured group, the levels of E2, AMH, FSH, AFC and PSV had no significant discrepancy (P>0.05). For the electrocoagulation group, the levels of E2, AMH, AFC and PSV decreased significantly after operation, while the levels of FSH increased significant (P<0.05). For the level of LH, there was no significantly discrepancy between two groups (P>0.05). The decreases of E2, AMH, AFC and PSV in the bipolar electrocoagulation group at 1 and 6 months postoperatively were more significant than those in the sutured group (P<0.05). And the level of FSH increased significantly in the bipolar electrocoagulation group compared to the sutured group (P<0.05). Six patients experienced a decline in ovarian reserve function in both two groups (suture group:n=2;electrocoagulation group: n=4). Conclusion Different methods of hemostasis during laparoscopic ovarian cyst excision would cause different impacts on ovarian reserve function. The use of bipolar electrocoagulation could decline ovarian reserve function more obvious than the sutured group.