腹腔镜卵巢肿瘤剥除术的止血方式选择及其对患者性激素水平的影响  

Choice of hemostasis modes for laparoscopic ovarian tumor dissection and its effect on the sex hormone levels in patients

作　　者：陈体平[1] 彭诗寒[1] 罗丹[1] CHEN Tiping;PENG Shihan;LUO Dan(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：《中国性科学》2020年第4期82-85,共4页Chinese Journal of Human Sexuality

摘　　要：目的观察不同腹腔镜卵巢肿瘤剥除术止血方式(单纯缝合止血、电凝止血、超声刀止血)对卵巢型子宫内膜异位症患者性激素水平的影响。方法选取2017年2月至2018年2月泸州市人民医院184例卵巢型内异症囊肿合并不孕患者作为研究对象。按卵巢型内异症囊肿剥除术止血方式选择差异分为缝合止血组(n=66)、电凝止血组(n=67)和超声刀止血组(n=61)。比较三组术后近期(6个月)和远期(12个月)的性激素指标(FSH、LH、E2、AMH)、卵巢储备功能指标(PSV、FO)及妊娠率。结果在术后近期(6个月)和远期(12个月),电凝止血组和超声刀止血组的性激素指标(FSH、LH、E2、AMH)比较差异均无统计学意义(均P>0.05)。但在术后远期(12个月),电凝止血组、超声刀止血组的E2低于缝合止血组,而电凝止血组、超声刀止血组的AMH高于缝合止血组,差异具有统计学意义(P<0.05)。在术后近期(6个月)和远期(12个月),电凝止血组、超声刀止血组的卵巢储备功能指标(PSV、FO)高于缝合止血组,差异均具有统计学意义(均P<0.05);在术后远期(12个月),电凝止血组、超声刀止血组术后自然妊娠率(62.7%、63.9%)显著高于缝合止血组,差异均具有统计学意义(48.2%,P<0.05)。结论与单纯缝合止血方式比较,电凝止血或超声刀止血对卵巢型子宫内膜异位症患者的性激素分泌影响较小,利于患者卵巢储备功能的恢复,电凝止血或超声刀止血均是腹腔镜卵巢肿瘤剥除术的较理想止血方法。Objective To observe the effects of hemostasis methods(simple suture hemostasis, electrocoagulation hemostasis, ultrasound scalpel hemostasis) on the sex hormone levels in patients with ovarian endometriosis. Methods From February 2017 to February 2018, 184 patients with ovarian endometriosis cyst complicated with infertility were divided into simple suture group(66 cases), electrocoagulation hemostasis group(67 cases) and ultrasound scalpel hemostasis group(61 cases). The short-term(6 months) and long-term(12 months) sex hormone indicators(FSH, LH, E2, AMH), ovarian reserve function indicators(PSV, FO) and pregnancy rate were compared among the three groups. Results There was no statistically significant differences in the sex hormone indexes(FSH, LH, E2, AMH) between the electrocoagulation hemostasis group and ultrasound scalpel hemostasis group in the short term(6 months) and long term(12 months) after operation(all P>0.05). In the long term(12 months), E2 in electrocoagulation hemostasis group and ultrasound knife hemostasis group was lower than that in suture hemostasis group, while AMH in electrocoagulation hemostasis group and ultrasound knife hemostasis group was higher than that in suture hemostasis group, all with statistically significant differences(P<0.05). In the short term(6 months) and long term(12 months), ovarian reserve function(PSV, FO) in electrocoagulation hemostasis group and ultrasound scalpel hemostasis group were significantly higher than those in suture hemostasis group(P < 0.05) and the pregnancy rate(62.7%, 63.9%) was significantly higher than that of suture hemostasis group(48.2%, P<0.05). Conclusions Compared with simple suture hemostasis, electrocoagulation hemostasis or ultrasound scalpel hemostasis has less effect on sex hormone secretion in patients with ovarian endometriosis, which is conducive to the recovery of ovarian reserve function. Electrocoagulation hemostasis or ultrasound scalpel hemostasis are ideal hemostasis methods for laparoscopic ovarian tumor removal.

关 键 词：卵巢型子宫内膜异位症 腹腔镜 止血方式 肿瘤剥除术 性激素 

分 类 号：R711[医药卫生—妇产科学]