摘要
目的探讨腹腔镜下卵巢囊肿剔除术中卵巢创面采用电凝或缝合止血方法对卵巢储备功能的影响。方法应用随机分组法将2006年3月～2010年3月我科因卵巢囊肿行腹腔镜下卵巢囊肿剔除术的150例分为2组,术中创面止血采用缝合法或电凝法,其中单侧缝合组37例,双侧缝合组38例,单侧电凝组39例,双侧电凝组36例。于术前1个月及术后第6个月月经第3天上午抽血查基础性激素水平(FSH、LH、E2),同时阴道彩色多普勒超声检查,测卵巢大小、卵巢间质动脉血流的收缩期峰值(PSV),窦卵泡数(F0),以评判手术对卵巢储备功能的影响。结果 4组术前一般情况和卵巢储备功能差异无显著性(P>0.05)。4组术后卵巢功能评价:术后6个月双侧卵巢囊肿电凝组FSH、E2水平较术前明显升高(P<0.01),单侧卵巢囊肿不论电凝组还是缝合组FSH、E2均无明显改变(P>0.05)。单侧卵巢囊肿的缝合组和电凝组术后FSH、E2水平没有明显差异(P均>0.05),而双侧卵巢囊肿电凝组术后FSH、E2的水平明显高于缝合组(P均<0.01)。电凝组术后卵巢大小、PSV、F0较缝合组明显减少(P<0.01)。单侧卵巢囊肿中,电凝组囊肿侧的窦卵泡数较正常侧明显减少(t=7.87,P<0.01),但缝合组中囊肿侧和正常侧窦卵泡数差异无显著性(t=1.45,P>0.05);电凝组囊肿侧术后窦卵泡数较术前明显减少(P<0.01),而缝合组术后窦卵泡数与术前相比无明显差异(P>0.05)。4组共发生卵巢储备功能减退6例,均发生在双侧卵巢囊肿电凝组。结论腹腔镜下卵巢囊肿剔除术中用电凝法进行卵巢创面的电凝止血,可造成术后卵巢储备功能减退,建议术中避免使用电凝止血法,采用缝合法进行卵巢创面的止血整形。
Objective To compare the impact of suturing and electric coagulation for hemostasis on ovary reserve function after laparoscopic operation for benign ovary cyst. Methods Totally 150 patients with benign ovary cyst underwent laparoscopic surgery from March 2006 to March 2010 in our department. The patients were randomly divided into 4 groups according to hemostatic methods during the operation： lateral and bilateral suture groups and lateral and bilateral electric coagulation （EC） groups （37, 38, 39, and 36 cases respectively in the four groups）. Serum levels of FSH, LH, and E2 was detected one month before the operation, and six months postoperation （in the third morning of period of menses in the sixth month） ; meanwhile, vaginal Doppler sonography was carried out to measure the size of the ovary, PSV and F0 so that to evaluate the ovarian reserve function. Results No significant difference was observed in ovarian reservation function among the four groups before the operation （ P 〉 0.05 ）. Six months after the laparoscopy, the levels of FSH and E2 increased significantly in bilateral EC group compared to preoperation （P 〈 0. 01 ）; no significant change was noticed in the levels of FSH and E2 between lateral suture and lateral EC groups （ P 〉 0.05 ） , nor between lateral suture and lateral EC groups after the operation （P 〉 0.05 ） ; Whereas, the levels of FSH and E2 in the bilateral suture group were significantly lower than those in the bilateral EC group （P 〈 0.01 ）. The EC groups showed significantly decreased ovarian size, PSV and F0 （P 〈 0.01 ）. In the patients who received lateral hemostasis, in the EC groups, the F0 in the diseased side was significantly lower than that in the other side （ t = 7.87, P 〈 0.01 ）, while such difference was not observed in suture groups （ t = 1.45, P 〉 O. 05 ）.In the EC groups, the F0 in the diseased side decreased significantly compared to preoperation （P 〈 0.01 ）, such change was not detected in suture groups（P 〉 O. 05 ）. In the four groups, only 6 patients from the bilateral EC group developed ovarian reservation hypofunction after the treatment. Conclusions Electric coagulation during laparoscopic ovarian cystectomy may caase ovarian hypofunction,and therefore we suggest suturing in stead of electric coagulation for hemostasis during the procedure.
出处
《中国微创外科杂志》
CSCD
2011年第1期42-46,共5页
Chinese Journal of Minimally Invasive Surgery
基金
南京市医学科技发展项目(YKK06102)
关键词
卵巢囊肿
腹腔镜手术
电凝
缝合
Benign ovary cysts
Laparoscopic surgery
Electric coagulation
Suture
