间隙分离法对腹腔镜下卵巢子宫内膜异位囊肿剥除术后卵巢功能的保护价值  

The postoperative value of anatomical space seperation in laparoscopic cystectomy of ovarian endometriomas

作　　者：刘高焰 周春娅[1] 朱会蓉 刘鹏[1] 唐巧[1] LIU Gaoyan;ZHOU Chunya;ZHU Huirong;LIU Peng;TANG Qiao(Department of Obstetrics and Gynecology,Pengzhou People′s Hospital, Sichuan Pengzhou 611930, China)

机构地区：[1]四川省彭州市人民医院妇产科

出　　处：《新疆医科大学学报》2019年第7期907-910,共4页Journal of Xinjiang Medical University

基　　金：四川省卫生和计划生育委员会科研课题(150098)

摘　　要：目的探讨卵巢子宫内膜异位囊肿病灶间隙分离后再行剥除术对卵巢储备功能的保护价值。方法选取2013年1月-2018年1月在四川省彭州市人民医院妇产科行腹腔镜下双侧卵巢子宫内膜异位囊肿剥除术的患者60例,随机将患者分为研究组(病灶间隙生理盐水分离组)和对照组(直接剥除组),各30例。比较2组患者手术时间、手术前后血红蛋白变化量、术前及术后1、3、6个月基础状态的卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、抗苗勒管激素(AMH)水平及基础窦状卵泡数(AFC)和卵巢体积的差异。结果 2组患者切口愈合级别全部为甲级。研究组和对照组患者在手术时间、手术前后血红蛋白下降量和住院天数的比较上差异无统计学意义(P>0.05)。对照组术后1、3、6个月与术前相比,E2和AMH下降显著,FSH和LH升高显著,差异均有统计学意义(P<0.05);2组术后1、3、6个月的FSH、LH、E2和AMH水平比较,差异有统计学意义(P<0.05)。研究组中无患者发生卵巢储备功能(ovarianreserve,OR)下降及卵巢功能衰竭,对照组中有8例提示OR下降,但无患者提示卵巢功能衰竭。2组术后1、3、6个月的左、右侧卵巢体积较术前均缩小,差异有统计学意义(P<0.05);2组术后1、3、6个月的AFC个数比较,差异有统计学意义(P均<0.05)。结论腹腔镜下双侧卵巢子宫内膜异位囊肿剥除术后卵巢储备功能会受损,病灶间隙分离后再行剥除术与直接剥除术相比具有保护卵巢功能的作用,值得临床推广使用。Objective To investigate postoperative value of anatomical space separation in laparoscopic cystectomy of ovarian endometriomas. Methods 60 patients who underwent bilateral ovarian endometriosis cysts by laparoscopic cystectomy were enrolled from January 2013 to January 2018 in the Department of Obstetrics and Gynecology, Pengzhou People′s Hospital, Sichuan Province, and randomly divided into study group(interstitial saline separation group) and control group(direct removal group), 30 cases in each group. The differences of operation time, hemoglobin changes before and after operation, follicle stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2), anti-Mullerian hormone(AMH) levels and basal sinusoidal follicle count(AFC) before and 1, 3 and 6 months after operation were compared between the two groups. Results The wound healing grade of both groups was grade A. There was no significant difference between the study group and the control group in terms of operation time, hemoglobin decrease before and after operation, and hospitalization days(P>0.05). In the control group, E2 and AMH decreased significantly, while FSH and LH increased significantly at 1, 3 and 6 months after operation compared with those before operation(P<0.05);FSH, LH, E2 and AMH levels at 1, 3 and 6 months after operation in the two groups were significantly different(P<0.05). No patients in the study group had decreased ovarian reserve(OR) and ovarian failure, while 8 patients in the control group had decreased OR with no ovarian failure. The volume of left and right ovaries of the two groups decreased 1, 3 and 6 months after operation(P<0.05);the number of AFCs of the two groups at 1, 3 and 6 months after operation had statistically significant difference(P<0.05). Conclusion Separation of anatomical space is an efficient technique to protect the ovarian function when performing laparoscopic cystectomy for the patients with ovarian endometrioma. This surgical method is worthy of clinical application.

关 键 词：间隙分离 卵巢子宫内膜异位囊肿 卵巢储备功能 

分 类 号：R711.71[医药卫生—妇产科学]