不同手术方式对卵巢巧克力囊肿患者抗缪勒管激素水平和围术期指标的影响  

Effects of different surgery methods on anti-mullerian hormone level and perioperative indicators in ovarian chocolate cyst patients

作　　者：马丽 亓小利 施晓燕 MA Li;QI Xiaoli;SHI Xiaoyan(Department of Obstetrics and Gynecology,Bozhou People's Hospital of Anhui Province,Bozhou,Anhui,236800;Department of Obstetrics and Gynecology,Fuyang Hospital Affiliated to Anhui Medical University,Fuyang,Anhui,236000)

机构地区：[1]安徽省亳州市人民医院妇产科,安徽亳州236800 [2]安徽医科大学附属阜阳医院妇产科,安徽阜阳236000

出　　处：《实用临床医药杂志》2022年第14期79-83,共5页Journal of Clinical Medicine in Practice

摘　　要：目的比较不同手术方式对卵巢巧克力囊肿患者血清抗缪勒管激素(AMH)水平和围术期指标的影响,并分析患者术后不良妊娠结局的影响因素。方法回顾性选取102例卵巢巧克力囊肿患者作为研究对象,根据手术方式的不同分为腹腔镜组70例和开腹组32例。腹腔镜组采用腹腔镜下卵巢巧克力囊肿剥除术治疗,开腹组采用开腹囊肿剥除术治疗。观察并比较2组患者围术期指标、手术前后血清AMH水平,分析卵巢巧克力囊肿患者术后不良妊娠结局的影响因素。结果腹腔镜组手术时间(51.34±5.82)min、术中出血量(27.83±5.62)mL、住院时间(6.99±1.39)d、排气时间(10.71±1.63)h,分别短于或少于开腹组的(79.97±6.98)min、(50.16±15.24)mL、(11.66±1.49)d、(26.75±3.69)h,差异有统计学意义(P<0.05)。术后,腹腔镜组、开腹组AMH水平分别为(2.51±1.41)、(1.84±1.23)ng/mL,均低于术前,但腹腔镜组高于开腹组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、病程、囊肿患侧、盆腔粘连、输卵管功能、术前不孕、术后助孕、手术方式、AMH水平均为术后不良妊娠结局的独立影响因素(P<0.05)。术前AMH水平预测术后不良妊娠结局的曲线下面积为0.704,特异度为0.859,敏感度为0.763,界值为1.765。结论与开腹囊肿剥除术相比,腹腔镜下卵巢巧克力囊肿剥除术对患者血清AMH水平的影响更小,且各项围术期指标更优。年龄、病程、囊肿患侧、盆腔粘连、输卵管功能、术前不孕、术后助孕、手术方式、AMH水平均可影响卵巢巧克力囊肿患者术后妊娠结局,其中术前AMH水平可预测术后不良妊娠结局。Objective To analyze effect of varied surgeries the changes of serum anti-mullerian hormone(AMH)and influencing factors of adverse pregnancy in patients with ovarian chocolate cyst after laparoscopic surgery.Methods The clinical data of 102 patients with ovarian chocolate cyst treated in Bozhou People′s Hospital were collected retrospectively.They were divided into laparoscopy group(70 cases)and laparotomy group(32 cases)according to the operation methods.The laparoscopic group was treated with laparoscopic ovarian chocolate cyst exfoliation,and the open group was treated with laparotomy.The clinical indexes and the changes of serum AMH before and after operation were compared between the two groups,and the influencing factors of postoperative adverse pregnancy outcomes in patients with ovarian chocolate cyst were analyzed.Results The operation time(51.34±5.82)min,intraoperative bleeding(27.83±5.62)mL,hospital stay(6.99±1.39)d and exhaust time(10.71±1.63)h in the laparoscopic group were significantly lower or shorter than(79.97±6.98)min,(50.16±15.24)mL,(11.66±1.49)d and(26.75±3.69)h in the open group(P<0.05).After surgery,AMH levels in the laparoscopic group and the open group were(2.51±1.41)and(1.84±1.23)ng/mL,respectively,which were lower than those before surgery,but the above indicators in the laparoscopic group were higher than those in the open group(P<0.05).Multivariate Logistic regression analysis showed that age,course of disease,side of cyst,pelvic adhesion,fallopian tube function,preoperative infertility,postoperative assisted pregnancy,surgical method and AMH level were all independent influencing factors of postoperative adverse pregnancy outcomes(P<0.05).The area under the curve for preoperative AMH level in predicting postoperative adverse pregnancy outcome was 0.704,the specificity was 0.859,the sensitivity was 0.763,and the threshold was 1.765.Conclusion Compared with laparotomy,laparoscopic chocolate cyst removal of ovary has less effect on serum AMH levels and better perioperative i

关 键 词：腹腔镜 卵巢巧克力囊肿剥除术 抗缪勒管激素 妊娠结局 盆腔粘连 输卵管功能 

分 类 号：R711.71[医药卫生—妇产科学] R713[医药卫生—临床医学]