腹腔镜卵巢内异症囊肿剥除术中不同止血方法对卵巢储备功能的影响
복강경란소내이증낭종박제술중불동지혈방법대란소저비공능적영향
Impact on ovarian reserve function by different homostasis methods during laparoscopic cystectomy in treatment of ovarian endometrioma
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2013年 1期 11-15 ,共5页

    李长忠%韦德英%王飞%王洪庆%杨春润

    리장충%위덕영%왕비%왕홍경%양춘윤

    子宫内膜异位症%腹腔镜检查%止血,手术%卵泡刺激素%抗苗勒管激素%卵巢 子宮內膜異位癥%腹腔鏡檢查%止血,手術%卵泡刺激素%抗苗勒管激素%卵巢
    자궁내막이위증%복강경검사%지혈,수술%란포자격소%항묘륵관격소%란소
    Endometriosis%Laparoscopy%Hemostasis,surgical%Follicle stimulating hormone%Anti-mullerian hormone%Ovary
    目的 探讨腹腔镜卵巢内异症囊肿剥除术中使用不同止血方法对卵巢储备功能的影响.方法 选择2008年9月至2010年2月在山东大学附属省立医院住院治疗的卵巢内异症囊肿患者162例,于术前月经周期第3天,晨起抽取空腹静脉血查FSH和抗苗勒管激素(AMH)水平,超声测量双侧卵巢基础窦卵泡计数(AFC)和卵巢基质动脉血流的收缩期峰值(PSV).采用随机数字表法将患者分为3组,行常规腹腔镜卵巢内异症囊肿剥除术,术中分别在剥除囊肿后采用双极电凝(双极电凝组,54例)、超声刀(超声刀组,54例)和缝合(缝合组,54例)法止血.术后第1、3、6、12次月经周期第3天,复查FSH、AMH水平及AFC和PSV,比较腹腔镜术中不同止血方法对卵巢储备功能的影响.结果 (1)术前情况:各组患者年龄、卵巢内异症囊肿大小、术前FSH、AMH水平及AFC、PSV水平比较,差异均无统计学意义(P＞0.05).(2)术后卵巢储备功能变化:①FSH:术后1、3、6、12个月时,双极电凝组FSH水平分别为(11.7±4.0)、(9.9±4.0)、(9.5±4.3)、(9.5±3.9)U/L,超声刀组分别为(11.4±4.3)、(9.7±4.0)、(9.2±3.7)、(9.9 ±4.6) U/L,均明显高于缝合组的(9.3±3.8)、(6.7±3.0)、(6.5±3.2)、(6.4±2.2) U/L,分别比较,差异均有统计学意义(P＜0.05).②AMH:术后1、3、6、12个月时,双极电凝组AMH水平分别为(1.8±0.9)、(1.8±1.0)、(1.9±1.0)、(2.0±1.0) μg/L,超声刀组分别为(1.6±0.8)、(1.8±1.0)、(2.0±1.1)、(2.1±1.0)μg/L,均明显低于缝合组的(2.8±1.7)、(2.9±1.6)、(3.0±1.3)、(3.2±1.5)μg/L,分别比较,差异也有统计学意义(P＜0.05).③AFC:手术后1个月时,各组患者的AFC比较,差异无统计学意义(P＞0.05),但术后3、6、12个月时,缝合组的AFC分别为(4.8±1.4)、(5.9±1.5)、(6.1±1.5)个,明显高于双极电凝组的(3.7±1.4)、(4.1±1.4)、(4.0±1.5)个和超声刀组的(3.6±1.3)、(4.0±1.1)、(3.9±1.5)个,分别比较,差异均有统计学意义(P＜0.05).④PSV:术后1、3、6、12个月时,双极电凝组PSV分别为(7.9±3.5)、(8.1±3.3)、(8.4±3.1)、(8.6±3.0) cm/s,超声刀组分别为(8.1±3.5)、(8.0±3.0)、(7.9±3.2)、(8.0±2.9) cm/s,均明显低于缝合组的(10.9±3.3)、(12.0±3.2)、(1 1.8±3.0)、(12.1 ±4.1)cm/s,分别比较,差异均有统计学意义(P＜0.05).结论 腹腔镜卵巢内异症囊肿剥除术中,应用双极电凝或超声刀止血会导致卵巢储备功能下降,应该慎用电凝烧灼方式止血.
    목적 탐토복강경란소내이증낭종박제술중사용불동지혈방법대란소저비공능적영향.방법 선택2008년9월지2010년2월재산동대학부속성립의원주원치료적란소내이증낭종환자162례,우술전월경주기제3천,신기추취공복정맥혈사FSH화항묘륵관격소(AMH)수평,초성측량쌍측란소기출두란포계수(AFC)화란소기질동맥혈류적수축기봉치(PSV).채용수궤수자표법장환자분위3조,행상규복강경란소내이증낭종박제술,술중분별재박제낭종후채용쌍겁전응(쌍겁전응조,54례)、초성도(초성도조,54례)화봉합(봉합조,54례)법지혈.술후제1、3、6、12차월경주기제3천,복사FSH、AMH수평급AFC화PSV,비교복강경술중불동지혈방법대란소저비공능적영향.결과 (1)술전정황:각조환자년령、란소내이증낭종대소、술전FSH、AMH수평급AFC、PSV수평비교,차이균무통계학의의(P＞0.05).(2)술후란소저비공능변화:①FSH:술후1、3、6、12개월시,쌍겁전응조FSH수평분별위(11.7±4.0)、(9.9±4.0)、(9.5±4.3)、(9.5±3.9)U/L,초성도조분별위(11.4±4.3)、(9.7±4.0)、(9.2±3.7)、(9.9 ±4.6) U/L,균명현고우봉합조적(9.3±3.8)、(6.7±3.0)、(6.5±3.2)、(6.4±2.2) U/L,분별비교,차이균유통계학의의(P＜0.05).②AMH:술후1、3、6、12개월시,쌍겁전응조AMH수평분별위(1.8±0.9)、(1.8±1.0)、(1.9±1.0)、(2.0±1.0) μg/L,초성도조분별위(1.6±0.8)、(1.8±1.0)、(2.0±1.1)、(2.1±1.0)μg/L,균명현저우봉합조적(2.8±1.7)、(2.9±1.6)、(3.0±1.3)、(3.2±1.5)μg/L,분별비교,차이야유통계학의의(P＜0.05).③AFC:수술후1개월시,각조환자적AFC비교,차이무통계학의의(P＞0.05),단술후3、6、12개월시,봉합조적AFC분별위(4.8±1.4)、(5.9±1.5)、(6.1±1.5)개,명현고우쌍겁전응조적(3.7±1.4)、(4.1±1.4)、(4.0±1.5)개화초성도조적(3.6±1.3)、(4.0±1.1)、(3.9±1.5)개,분별비교,차이균유통계학의의(P＜0.05).④PSV:술후1、3、6、12개월시,쌍겁전응조PSV분별위(7.9±3.5)、(8.1±3.3)、(8.4±3.1)、(8.6±3.0) cm/s,초성도조분별위(8.1±3.5)、(8.0±3.0)、(7.9±3.2)、(8.0±2.9) cm/s,균명현저우봉합조적(10.9±3.3)、(12.0±3.2)、(1 1.8±3.0)、(12.1 ±4.1)cm/s,분별비교,차이균유통계학의의(P＜0.05).결론 복강경란소내이증낭종박제술중,응용쌍겁전응혹초성도지혈회도치란소저비공능하강,응해신용전응소작방식지혈.
    Objective To investigate the impact on ovarian reserve function by different hemostasis methods during laparoscopic surgery in treatment of ovarian endometrioma.Methods From September 2008 to February 2010,162 cases with ovarian endometrioma undergoing laparoscopic surgery in Shandong Provincial Hospital were enrolled in this study.At the 3rd day of the menstrual cycle before surgery and the 1 st,3rd,6th and 12th cycle after surgery,serum FSH and anti-mullerian hormone(AMH) and ultrasound basal antral follicle count (AFC) and peak systolic velocity (PSV) were examined and compared.Based on hemostasis method,those patients were divided into 3 groups,including 54 cases in bipolar hemostasis,54 cases in ultrasonic scalpel hemostasis and suture after excision of endometrioma.Results (1) Before surgery:no significant different factors among three groups before surgery were observed,including age,size of endometrioma,the level of FSH,AMH,AFC,PSV (P ＞ 0.05).(2) Ovarian reserve function after surgery:①FSH:at the 1st,3rd,6th and 12th month follow-up,the FSH in the bipolar group was (11.7 ±4.0),(9.9 ± 4.0),(9.5 ± 4.3),(9.5 ± 3.9) U/L,and the FSH in ultrasonic scalpel group was (11.4 ±4.3),(9.7 ± 4.0),(9.2 ± 3.7),(9.9 ± 4.6) U/L,were significantly higher than (9.3 ± 3.8),(6.7 ±3.0),(6.5 ± 3.2),(6.4 ± 2.2) U/L in suture group respectively (all P ＜ 0.05).()AMH:at the 1 st,3rd,6th and 12th month follow-up,the AMH in the bipolar group was (1.8 ±0.9),(1.8 ± 1.0),(1.9 ±1.0),(2.0 ± 1.0) μg/L,and the AMH in the ultrasonic scalpel group was (1.6 ±± 0.8),(1.8 ± 1.0),(2.0 ± 1.1),(2.1 ± 1.0) μg/L,which were significantly lower than (2.8 ± 1.7),(2.9 ± 1.6),(3.0 ±1.3),(3.2 ± 1.5) μg/L in suture group,respectively (all P ＜ 0.05).③AFC:there was no significant difference of APC among the three groups in the 1st month after surgery.However,at the 3rd,6th and 12th month follow-up,the AFC of 4.8 ± 1.4,5.9 ± 1.5,6.1 ± 1.5 in the suture group was significant higher than 3.7 ± 1.4,4.1 ± 1.4,4.0 ± 1.5 in bipolar group and 3.6 ± 1.3,4.0 ± 1.1,3.9 ± 1.5 in ultrasonic group,respectively (all P ＜ 0.05).④PSV:at the 1 st,3rd,6th and 12th month follow-up,the PSV of the bipolar group(7.9 ±3.5),(8.1 ±3.3),(8.4 ±3.1),(8.6±3.0) cm/s in bipolar group and (8.1 ±3.5),(8.0 ± 3.0),(7.9 ± 3.2),(8.0 ± 2.9) cm/s in ultrasonic group were significant lower than (10.9 ± 3.3),(12.0 ± 3.2),(11.8 ± 3.0),(12.1 ± 4.1) cm/s in suture group,respectively.(allP＜0.05).Conclusions Bipolar or ultrasonic scalpel hemostasis during laparoscopic excision of ovarian endometrioma is associated with a significant reduction in ovarian reserve.Electrocoagulation of the ovarian tissue should be avoided.
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