摘要
目的:探讨未生育妇女卵巢子宫内膜异位症(内异症)囊肿剥除术中不同止血方法对卵巢储备功能的影响。方法:选择在本院妇计科因单侧卵巢内异囊肿初次住院行卵巢内异症囊肿剥除术的未生育患者80例,患者经行腹腔镜手术41例,开腹手术39例,因术中卵巢剥离创面采用不同的止血方法将患者分为两组,止血采用单纯缝合方法(缝合组)和采用电凝止血方法(电凝组)。其中腹腔镜电凝组21例,缝合组20例;开腹电凝组19例,缝合组20例。于术前、术后第6次月经及术后12个月后第1次月经的第2～3天,分别检测患者血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇水平,阴道B超检测窦状卵泡数(F0)、卵巢间质动脉血流的收缩期峰值(PSV)及卵巢体积(V),以判断卵巢储备功能。两组患者术前一般状况和卵巢储备功能比较,差异无统计学意义(P>0.05)。结果:两组患者各项指标除LH水平外FSH、E2、Fo、PSV、V,术后6个月、术后12个月与术前比较差异均有统计学意义(P<0.05);术后6,12个月较术前FSH升高,E2、Fo、PSV、V降低。两组患者LH水平比较,差异无统计学意义(P>0.05)。电凝组与缝合组比较,电凝组在术后6个月时,上述改变更明显,差异均有统计学意义(P<0.05)。各项指标FSH、LH、E2、Fo、PSV、V在术后6个月与术后12个月比较差异无统计学意义(P>0.05)。结论:卵巢内异症囊肿剥除术后可能造成卵巢储备功能下降,创面出血采用电凝止血方式较缝合止血方式对卵巢储备功能下降影响更明显。提示临床医生多用缝合法处理残留卵巢,如需应用电凝止血也应缩短电凝时间,采用鼓点式电凝,减少电灼组织的面积,尤其是对卵巢门部位的电凝,避免电凝对卵巢组织的热损伤,让患者得到真正意义上的微创治疗。
Objective： To discuss the effect of different hemostasis methods on the ovarian reserve functions in the cystectom nonparous women admitte Y d for ovarian endometriomas of nonparous women. Methods： 80 cases of into the hospital for the first time from October of 2009 to June of 2011 due to unilateral ovarian cysts were selected to perform cystectomy for ovarian endometriomas, of which, 41 cases were performed laparoscopic surgery, 39 laparotomy. Patients were divided into 2 groups, the simple suture hemostasis method due to the different hemostasis methods used in group the in and the electrocoagulation hemostasis group traoperative ovarian stripping wounds. In the laparoscopic surgery group, 21 cases adopted laparoscopic electrocoagulation hemostasis method and 20 cases used simple suture hemostasis method; while in the laparotomy group, 19 cases adopt- ed electrocoagulation hemostasis method and 20 cases applied simple suture tiemostasis method. In the 6th menstruation pre and postoperations, and 2nd and the 3rd day of the first menstruation 12 months after operations, the follicular stimulating hormone （FSH）, luteinizing hormone （LH）, es- tradiol level, sinus-shape follicle （Fo） number detected by vinginal ultrasound, peak systolic veloci- ty （PSV） of the ovarian stroma artery blood flow and the ovarian volume （V） of the patients were detected respectively to determine the ovarian reserve functions. The results of comparing the pre- operative general situation and the ovarian reserve functions of the patients in the 2 groups indicated that there was no statistical difference （P〉0.05）. Results： There were statistical difference of all the indications in both groups except LH level 6 months and 12 months after surgeries compared with the indications before surgeries （P〈0.05）. The indications of SH went up while E2, Fo num- ber, PSV, V decresed in both groups 6 months and 12 months after operation compared with those before operation. 0.05）. Compare Compared the LH level of
出处
《华夏医学》
CAS
2013年第1期87-92,共6页
Acta Medicinae Sinica
基金
广西壮族自治区卫生厅科研课题基金资助(Z2009050)
