摘要
目的:探讨腹腔镜下卵巢子宫内膜异位囊肿(OEC)剥除术中应用不同止血方式对患者卵巢储备功能、月经及性激素水平的影响。方法:病例源于2016年1月至2019年1月我院收治的106例OEC患者,根据患者手术方式分为对照组(双极电凝进行止血,n=53)和观察组(镜下缝合进行止血,n=53),比较两组卵巢储备功能[窦状卵泡数目(AFC)、患侧卵巢动脉收缩期峰值血流速度(PSV)]、性激素[卵泡刺激激素(FSH)、黄体生成素(LH)、雌二醇(E 2)]、月经恢复情况以及随访妊娠结局。结果:术前两组AFC、PSV、FSH、LH、E 2、月经时间、月经周期比较无明显差异(P>0.05);术后3、6个月,观察组AFC、PSV相比术前无明显差异(P>0.05),对照组AFC、PSV相比术前明显降低(P<0.05),且观察组AFC、PSV明显高于对照组(P<0.05)。治疗前后观察组月经时间、月经周期的差值均大于对照组(P<0.05)。术后6个月观察组FSH、LH、E 2水平相比术前无明显差异(P>0.05),对照组FSH、LH水平明显增高,E 2水平明显降低(P<0.05);治疗前后观察组FSH、LH、E 2的差值均小于对照组(P<0.05)。观察组术后1年自然妊娠率33.96%明显高于对照组15.09%(P<0.05)。结论:与电凝止血法比较,缝合止血方法对OEC剥除术患者卵巢功能损伤更轻微,有利于患者月经恢复以及性激素水平的稳定,临床积极作用更显著。
Objective:To investigate the effects of different hemostatic methods used in laparoscopic cystectomy for ovarian endometriosis cyst(OEC)on ovarian reserve function,menstruation and sex hormone levels.Methods:106 patients with OEC who were admitted to the hospital from January 2016 to January 2019 were selected as the subjects.They were divided into the control group(bipolar coagulation hemostasis,n=53)and the observation group(suture hemostasis under laparoscope,n=53)according to the operation method.The ovarian reserve function[antral follicle count(AFC),ovarian artery peak systolic velocity(PSV)at affected side ovarian artery],sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E 2)],menstrual recovery and follow-up pregnancy outcomes were compared between the two groups.Results:There were no significant differences in AFC,PSV,FSH,LH,E 2,menstrual time or menstrual cycle between the two groups before operation(P>0.05).There was no significant difference in AFC or PSV in the observation group at 3rd and 6th month months after operation,compared with those before operation(P>0.05).AFC and PSV in the control group were significantly lower than those before operation(P<0.05).Besides,AFC and PSV in the observation group were significantly higher than those in the control group(P<0.05).The difference of menstrual duration and menstrual cycle of the observation group before and after treatment was bigger than that of the control group(P<0.05).There was no significant difference in the level of FSH,LH or E 2 in the observation group at 6th month after operation,compared with those before operation(P>0.05).The levels of FSH and LH in the control group were significantly increased and E 2 levels were significantly decreased(P<0.05).The difference of L2,LH and E 2 in the observation group before and after treatment was smaller than that in the control group(P<0.05).The natural pregnancy rate of the observation group was 33.96%at 1 year after operation,significantly higher than that of the control group(15.09%)(P<0.05).Conclusion:Compared with bipolar coagulation hemostasis,suture hemostasis causes less damage to the ovarian reserve function in patients having undergone laparoscopic cystectomy for OEC.It is more conducive to menstrual recovery and stable sex hormone levels,and the clinical positive effect is more obvious。
作者
骆爱民
杜珍
陈志美
梁月珍
LUO Aimin;DU Zhen;CHEN Zhimei(The Second People's Hospital of Hainan Province,Hainan Wuzhishan 572299,China)
出处
《河北医学》
CAS
2020年第5期747-751,共5页
Hebei Medicine
基金
海南省卫生厅科学研究,(编号:琼卫2012P7-19)。
