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
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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.
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.
引文
[1] 戴毅,冷金花.盆腔子宫内膜异位症临床分型[J].中国实用妇科与产科杂志,2013,29(1):6-9.
[2] 刘平,马成斌.卵巢子宫内膜异位囊肿患者盆腔病灶分布与疼痛、不孕的相关性[J].中国妇幼保健,2014,29(1):25-28.
[3] 葛静,刘晶,都治香,等.腹腔镜卵巢囊肿剥除术对患者术后卵巢功能的近期和远期影响研究[J].中国内镜杂志,2013,19(9):927-931.
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[5] SHRIM A,ELIZUR S E,SEIDMAN D S,et al.Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian re-sponse[J].Reprod Biomed Online,2006,12(4):418-422.
[6] 周娟.腹腔镜下卵巢囊肿剥除术对卵巢功能的影响分析[J].现代诊断与疗,2016,27(1):151-152.
[7] 王建萍.腹腔镜卵巢囊肿剥除术对患者内分泌功能的影响[J].实用妇科内分泌电子杂志,2016,3(1):86-87.
[8] 程彦君,张德葵.腹腔镜下卵巢囊肿剔除术中不同止血方法对卵巢功能的影响[J].中国妇幼保健,2012,27(11):1646-1648.
[9] 胡文静,杨新华,艾星子·艾里,等.腹腔镜卵巢子宫内膜异位囊肿手术对卵巢储备功能影响的研究[J].新疆医科大学学报,2011,34(8):855-859.
[10] LI C Z,WEI D Y,WAND F,et al.Impact on ovarian reserve function by different homostasis methods during laparoscopic cystectomy in treament of ovarian endometrioma[J].Zhonghua Fu Chan Ke Za Zhi,2013,48(1):11-15.
[11] 杨冬梓,冯淑英.腹腔镜手术导致卵巢储备功能受损的认识与防护[J].实用妇产科杂志,2012,28(6):417-419.
[12] 冯兰青,黄惠英,王明波,等.两种止血法对卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响[J].分子诊断与治疗杂志,2013,9(5):324-327.
[2] 刘平,马成斌.卵巢子宫内膜异位囊肿患者盆腔病灶分布与疼痛、不孕的相关性[J].中国妇幼保健,2014,29(1):25-28.
[3] 葛静,刘晶,都治香,等.腹腔镜卵巢囊肿剥除术对患者术后卵巢功能的近期和远期影响研究[J].中国内镜杂志,2013,19(9):927-931.
[4] 胡琳莉,孙莹璞.卵泡发育调控和促排卵[J].中国实用妇科与产科杂志,2015,31(1):18-21.
[5] SHRIM A,ELIZUR S E,SEIDMAN D S,et al.Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian re-sponse[J].Reprod Biomed Online,2006,12(4):418-422.
[6] 周娟.腹腔镜下卵巢囊肿剥除术对卵巢功能的影响分析[J].现代诊断与疗,2016,27(1):151-152.
[7] 王建萍.腹腔镜卵巢囊肿剥除术对患者内分泌功能的影响[J].实用妇科内分泌电子杂志,2016,3(1):86-87.
[8] 程彦君,张德葵.腹腔镜下卵巢囊肿剔除术中不同止血方法对卵巢功能的影响[J].中国妇幼保健,2012,27(11):1646-1648.
[9] 胡文静,杨新华,艾星子·艾里,等.腹腔镜卵巢子宫内膜异位囊肿手术对卵巢储备功能影响的研究[J].新疆医科大学学报,2011,34(8):855-859.
[10] LI C Z,WEI D Y,WAND F,et al.Impact on ovarian reserve function by different homostasis methods during laparoscopic cystectomy in treament of ovarian endometrioma[J].Zhonghua Fu Chan Ke Za Zhi,2013,48(1):11-15.
[11] 杨冬梓,冯淑英.腹腔镜手术导致卵巢储备功能受损的认识与防护[J].实用妇产科杂志,2012,28(6):417-419.
[12] 冯兰青,黄惠英,王明波,等.两种止血法对卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响[J].分子诊断与治疗杂志,2013,9(5):324-327.