腹腔镜卵巢内膜异位症囊肿剥除术中不同止血方法对卵巢储备功能的影响及术后疗效分析  

Impact on Ovarian Reserve Function by Different Hemostasis Methods after Laparoscopic Excision of Ovarian Endometrioma

作　　者：周婷[1] 邹放军[1] 

机构地区：[1]湖南省人民医院妇科,长沙410005

出　　处：《中国现代手术学杂志》2013年第5期382-385,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腹腔镜卵巢子宫内膜异位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2010年1月至2011年12月在湖南省人民医院妇产科住院,初步诊断为卵巢子宫内膜异位症囊肿的120例患者。入院前病人在月经第3 d早晨抽取空腹静脉血,查内分泌全套,包括促卵泡激素(follicle-stimulating hormone,FSH)。同时行阴道彩色超声检查,测量双侧卵巢基础窦卵泡计数(antral follicle count,AFC)。根据止血方法的不同将患者分为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缝合法(缝合组,60例)、双极电凝法(双极电凝组,30例)和超声刀法(超声刀组,30例)止血。术后第1、3、6、12次月经周期第3d,复查FSH水平及AFC,比较腹腔镜术中不同止血方法对卵巢储备功能的影响。结果各组患者年龄、卵巢子宫内膜异位症囊肿大小、术前FSH水平和AFC水平比较,差异均无统计学意义(P>0.05)。术后卵巢储备功能变化:①FSH:术后1、3、6、12个月时,双极电凝和超声刀组均明显高于缝合组,差异均有统计学意义(P<0.05)。②AFC:手术后1个月和3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6、12个月时,缝合组的AFC明显高于双极电凝组和超声刀组,差异均有统计学意义(P<0.05)。③术后自然妊娠率:术后18月内,缝合组术后妊娠率均高于双极电凝组及超声刀组,但差异无统计学意义(P>0.05)。结论腹腔镜卵巢子宫内膜异位症囊肿剥除术中,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。Objective To investigate the impact on ovarian reserve function by different hemostasis methods during laparoscopic surgery in treatment of ovarian endometrioma. Methods From January 2010 to December 2011,120 cases with ovarian endometrioma undergoing laparoseopie surgery in Hunan Provincial Hos- pital 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 ultrasound basal antral follicle count（AFC） were examined and com- pared. Based on the hemostasis methods ,those patients were divided into 3 groups, including 60 cases in suture after excision, 30 cases in bipolar hemostasis and 30 cases in ultrasonic scalpel hemostasis. Results Before surgery, no significant different factors among three groups were observed, including age, size of endometrioma and the level of FSH and AFC （ P 〉 0.05 ）. After surgery, There was no significant difference of FSH at the 1st and 3rd month, but at the 6th and 12th month fallow-up, the FSH in the bipolar group and ultrasonic scalpel group were significantly higher than that of suture group respectively. There was no significant difference of AFC among the three groups in the 1 st and the 3 rd month after surgery. However, at the 6th and 12th month follow up, the AFC of the suture group was significant higher than bipolar group and ultrasonic group respectively （ all P 〈0.05）. The pregnancy rate of the suture group at 18th mouth was higher than bipolar group and ultrasonic group respectively, but the difference was not statisticaUy significant （ P 〉 O. 05 ）. Conclusions Bipolar or ultrasonic scalpel hemostasis during laparoscopic excision of ovarian endometrioma is associated with a signifi- cant reduction in ovarian reserve. Electrocoagulation of the ovarian tissue should be avoided.

关 键 词：子宫内膜异位症 腹腔镜检查 止血 手术 卵泡刺激素 人 

分 类 号：R713.6[医药卫生—妇产科学]