腹腔镜下改良锐性剥离术式对卵巢性EMS患者围术期指标和卵巢功能及术后并发症的影响  

Effect of improved laparoscopic sharp decollement on perioperative indexes, ovarian function and postoperative complications in patients with ovarian endometriosis

作　　者：成文俊[1] 陈蓉[1] 张杨[1] 罗玉萍 CHENG Wenjun;CHEN Rong;ZHANG Yang;LUO Yuping(Department of Obstetrics and Gynecology,Luzhou People's Hospital,Luzhou 646000,Sichuan,China)

机构地区：[1]泸州市人民医院妇产科,四川泸州646000

出　　处：《西部医学》2019年第5期723-726,730,共5页Medical Journal of West China

基　　金：四川省科技厅科技支撑计划项目(20123203214)

摘　　要：目的探讨腹腔镜下改良锐性剥离术式对卵巢性子宫内膜异位症(EMs)患者围术期指标、卵巢功能及术后并发症的影响。方法选取2013年1月～2016年12月我院收治的卵巢性EMs患者90例为研究对象,随机分为观察组和对照组,每组各45例,对照组给予腹腔镜下常规钝性剥离术,观察组实施改良锐性剥离术,记录两组围术期指标、手术前后性激素[黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)]水平、卵巢功能[窦卵泡数(AFC)、卵巢体积]及并发症。结果观察组术中出血量低于对照组(P<0.01),且观察组卵巢中间及卵巢门部位剥除病灶厚度、卵巢皮质剥除厚度小于对照组(P<0.01);两组手术时间、住院时间比较差异无统计学意义(P>0.05);手术前后两组LH、FSH、E_2水平比较差异无统计学意义(P>0.05);术后两组AFC、卵巢体积均减小,但观察组术后AFC、卵巢体积大于对照组(P<0.01);两组术后并发症比较差异无统计学意义(P>0.05)。结论腹腔镜下改良锐性剥离术治疗卵巢性子宫内膜异位症时,术中出血量少,卵巢中间与卵巢门部位剥除病灶厚度、卵巢皮质剥除厚度小,可较好保留卵巢功能,且安全可靠,可在临床推广应用。Objective To analyze the influence of improved laparoscopic sharp decollement on perioperative indicators,ovarian function and postoperative complications in patients with ovarian endometriosis (EMs).Methods 90 patients with ovarian EMs admitted to the hospital from January 2013 to December 2016 were selected as the subjects.They were randomly divided into the observation group and the control group,45 cases in each group.The control group was treated by routine laparoscopic blunt decollement,while the observation group was treated by improved sharp decollement.The perioperative indicators,levels of sex hormones [luteinizing hormone (LH),follicle stimulating hormone (FSH),estradiol (E 2)]before and after operation,ovarian function [antral follicle count (AFC) ovarian volume]and complications in the two groups were recorded.Results The intraoperative blood loss of observation group was less than that of the control group ( P <0.01).The thickness of removed lesions at central ovary and ovarian hilum and the thickness of removed ovarian cortex in the observation group was smaller than that in the control group ( P <0.01).There was no significant difference between the two groups in operation time or hospital stay ( P >0.05).There was no significant difference in the levels of LH,FSH and E 2 between the two groups before and after operation ( P >0.05).The AFC and ovarian volume of the two groups were decreased after operation,but the AFC and ovary volume of the observation group were larger than those of the control group ( P <0.01).There was no significant difference in the incidence of postoperative complications between the two groups (11.10% vs 15.54%)( P >0.05).Conclusion Under improved laparoscopic sharp decollement,the blood loss is less,the thickness of removed lesions at central ovary and ovarian hilum and the thickness of removed ovarian cortex is small.The treatment can well preserve the ovarian function.It's safe and reliable.

关 键 词：卵巢性子宫内膜异位症 腹腔镜 改良锐性剥离术 围术期 卵巢功能 

分 类 号：R711.72[医药卫生—妇产科学]