CAJ | 학술논문

目的：探讨腹腔镜下卵巢巧克力囊肿剥除术中采用不同止血方法对术后卵巢功能的影响。方法单侧卵巢巧克力囊肿患者80例，按随机数字表法分为电凝组40例，缝合组40例，均施行腹腔镜下囊肿剥除术，术中创面止血分别采用双极电凝止血和缝合止血。观察两组患者术前和术后1个月、3个月、6个月及12个月促卵泡生成素（ FSH）、促黄体生成素（ LH）、雌二醇（ E2）水平，同时行阴道彩色多普勒超声检查，测量卵巢大小、窦卵泡数（ F0）、卵巢间质动脉血流的收缩期峰值流速（PSV）、舒张期低值流速（EDV），计算阻力指数（RI）、搏动指数（PI）。结果电凝对术后各项卵巢性激素指标的影响均大于缝合术，电凝组FSH、LH水平在术后第1个月达到最高，E2测量值术后第1个月降至最低，术后6个月均恢复至术前水平（P＜0．05）。电凝对术后各项阴道超声检查指标的影响均大于缝合术，术后两组的卵巢大小均恢复至正常水平（ P＜0．05），窦卵泡数测量值在术后第一个月降至最低，缝合组从术后3个月开始缓慢增长至术前水平，电凝组直至术后1年仍维持在较低水平（P＜0．05）；PSV、EDV均在术后3个月恢复至正常（P＜0．05）。结论腹腔镜下卵巢巧克力囊肿剔除术中采用双极电凝止血或缝合法止血均对卵巢储备功能造成影响，尤以电凝止血法对卵巢功能的影响更为明显。大部分患者的卵巢功能在术后半年内可基本恢复正常。
목적：탐토복강경하란소교극력낭종박제술중채용불동지혈방법대술후란소공능적영향。방법단측란소교극력낭종환자80례，안수궤수자표법분위전응조40례，봉합조40례，균시행복강경하낭종박제술，술중창면지혈분별채용쌍겁전응지혈화봉합지혈。관찰량조환자술전화술후1개월、3개월、6개월급12개월촉란포생성소（ FSH）、촉황체생성소（ LH）、자이순（ E2）수평，동시행음도채색다보륵초성검사，측량란소대소、두란포수（ F0）、란소간질동맥혈류적수축기봉치류속（PSV）、서장기저치류속（EDV），계산조력지수（RI）、박동지수（PI）。결과전응대술후각항란소성격소지표적영향균대우봉합술，전응조FSH、LH수평재술후제1개월체도최고，E2측량치술후제1개월강지최저，술후6개월균회복지술전수평（P＜0．05）。전응대술후각항음도초성검사지표적영향균대우봉합술，술후량조적란소대소균회복지정상수평（ P＜0．05），두란포수측량치재술후제일개월강지최저，봉합조종술후3개월개시완만증장지술전수평，전응조직지술후1년잉유지재교저수평（P＜0．05）；PSV、EDV균재술후3개월회복지정상（P＜0．05）。결론복강경하란소교극력낭종척제술중채용쌍겁전응지혈혹봉합법지혈균대란소저비공능조성영향，우이전응지혈법대란소공능적영향경위명현。대부분환자적란소공능재술후반년내가기본회복정상。
Objective To explore the effects of different hemostasis methods applied to laparoscopic cystectomy for chocolate cyst of ovary on postoperative ovarian function.Methods Eighty patients with unilateral ovarian cyst who underwent laparoscopic cystectomy were randomly divided into electrocoagulation group and suture group,with 40 cases in each group.Patients in the electrocoagulation group received bipolar electrocoagulation hemostasis,and patients in the suture group received suture hemostasis.The levels of follicle stimulating hormone(FSH),luternizing hormone(LH) and estradiol(E2) were detected respectively before the operation,1,3,6 and 12 months after operation in two groups, transvaginal color Doppler ultrasonography was used to determine ovarian volume, basal antral follicle count (AFC),ovarian stromal peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI) and pulse index(PI) as well. Results Electrocoagulation had more significant effects on the postoperative indexes of ovarian sexual hormone compared with suture.The levels of FSH and LH achieved the highest while the level of E2 obtained the lowest in the first month after operation in the electrocoagulation group,and they achieved the levels as the preoperative in the sixth month after operation(P<0.05).Electrocoagulation had more significant effects on the postoperative indexes of transvaginal ultrasonography compared with suture,the ovarian volume came to normal after operation in two group(P<0.05),AFC obtained the lowest in the first month after operation,and then gradually increased to the preoperative three months after operation in the suture group while maintained a lower level one year after operation in the electrocoagulation group(P<0.05).PSV and EDV came to normal three months after operation(P<0.05).Conclusion Bipolar electrocoagulation hemostasis has more significant effects on ovarian reserve function compared with suture hemostasis during laparoscopic cystectomy for chocolate cyst of ovary .The ovarian reserve function might come to normal six months after operation in most of the patients.