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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (04) : 420 -424. doi: 10.3877/cma.j.issn.1673-5250.2021.04.007

论著

不同止血方式对腹腔镜下卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响
王玉, 盛洁, 靳灵鸽, 蒋子文, 卢丹†()   
  • 收稿日期:2021-04-01 修回日期:2021-07-10 出版日期:2021-08-01
  • 通信作者: 卢丹

Effects of different hemostatic methods on ovarian reservation after laparoscopic ovary endometrioma cystectomy

Yu Wang, Jie Sheng, Lingge Jin, Ziwen Jiang, Dan Lu†()   

  • Received:2021-04-01 Revised:2021-07-10 Published:2021-08-01
  • Corresponding author: Dan Lu
  • Supported by:
    National Natural Science Foundation of China(81801406)
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引用本文：

王玉, 盛洁, 靳灵鸽, 蒋子文, 卢丹. 不同止血方式对腹腔镜下卵巢子宫内膜异位囊肿剥除术后卵巢储备功能的影响[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(04): 420-424.

Yu Wang, Jie Sheng, Lingge Jin, Ziwen Jiang, Dan Lu. Effects of different hemostatic methods on ovarian reservation after laparoscopic ovary endometrioma cystectomy[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(04): 420-424.

目的

探讨双极电凝止血和缝合止血，对腹腔镜下卵巢囊肿剥除术(LOC)后，卵巢子宫内膜异位囊肿(OEC)患者卵巢储备功能(OR)的影响。

方法

选择2014年12月至2017年8月，于北京妇产医院接受LOC的159例中、重度OEC患者为研究对象。按照术中采取的止血方式，将其分为电凝组(n＝74，采用双极电凝止血)和缝合组(n＝85，采用缝合止血)。对2组患者术前双侧卵巢囊肿直径及血清抗苗勒管激素(AMH)水平，以及术后1年双侧卵巢直径及血清AMH水平，采用Mann-Whitney U检验进行统计学比较。本研究经北京妇产医院伦理委员会批准(审批文号：2016-KY-044-01)。所有受试者知情同意并签署知情同意书。

结果

①2组OEC患者年龄、人体质量指数、修正的美国生育学会(r-AFS)评分等比较，差异均无统计学意义(P>0.05)。②2组OEC患者LOC术前及术后1年血清AMH水平比较，以及术前双侧卵巢囊肿直径及术后1年双侧卵巢直径比较，差异均无统计学意义(P>0.05)。

结论

双极电凝止血和缝合止血，对OEC患者LOC术后1年的OR影响无明显差别。

关键词: 子宫内膜异位症, 腹腔镜, 电凝术, 止血, 抗苗勒管激素, 卵巢, 卵巢囊肿, 女(雌)性
Objective

To investigate effects of bipolar coagulation and suture hemostasis on ovarian reservation (OR) of patients with ovarian endometrial cysts (OEC) after laparoscopic ovarian cystectomy (LOC).

Methods

A total of 159 patients with moderate and severe OEC who underwent LOC in Beijing Obstetrics and Gynecology Hospital from December 2014 to August 2017 were selected as research subjects. According to hemostatic methods in LOC, they were divided into electrocoagulation group (n=74, stopped bleeding by bipolar electrocoagulation) and suture group (n=85, stopped bleeding by suture). Bilateral ovarian cysts diameter and serum anti-Mullerian hormone (AMH) level before LOC, and bilateral ovarian diameter and serum AMH level 1 year after LOC were compared between two groups by Mann-Whitney U test. The Ethics Committee of Beijing Obstetrics and Gynecology Hospital approved the study protocol (approval No. 2016-KY-044-01), and all the patients provided informed written consents.

Results

① There were no significant differences between two groups of OEC patients among age, body mass index and revised American Fertility Society (r-AFS) score (P>0.05). ② There were no significant differences between two groups of OEC patients in serum AMH levels before LOC and within 1 year after LOC, as well as diameter of bilateral ovarian cysts before LOC and diameter of bilateral ovary within 1 year after LOC (P>0.05).

Conclusion

There are no obvious different effects of bipolar coagulation hemostasis and suture hemostasis on OR of OEC patients within 1 year after LOC.

Key words: Endometriosis, Laparoscopes, Electrocoagulation, Hemostasis, Anti-Mullerian hormone, Ovary, Ovarian cysts, Female
图2 缝合组1例OEC患者(年龄为29岁，囊肿直径为7 cm) LOC术中，卵巢囊肿剥除后创面缝合止血过程(图2A、2B：缝合过程中卵巢创面出血多，故先采用止血纱布对创面进行压迫止血后，再缝合；图2C：止血纱布压迫后卵巢创面出血减少，继续缝合；图2D：缝合后卵巢创面未见出血)
表1 2组OEC患者一般临床资料及OR指标比较[M(P25~P75)]
组别 例数 年龄(岁) 人体质量指数(kg/m2) r-AFS评分(分) LOC术前 LOC术后1年
双侧卵巢囊肿直径(cm) 血清AMH水平(ng/mL) 双侧卵巢直径(cm) 血清AMH水平(ng/mL)
电凝组 74 31.0(28.0~35.0) 20.8(19.6~22.8) 65.5(35.5~88.3) 7(6~8) 3.0(1.8~5.6) 7.3(7.0~7.8) 1.9(0.9~3.4)
缝合组 85 30.0(27.0~35.5) 21.1(20.0~22.9) 68.0(42.0~87.5) 8(6~10) 3.1(1.9~4.7) 7.2(7.1~7.4) 2.3(1.2~4.2)
Z值   0.554 1.055 1.040 1.920 0.392 1.781 1.673
P值   0.580 0.291 0.298 0.055 0.695 0.075 0.094
图4 缝合组1例OEC患者(年龄为33岁，OEC直径为7.5 cm) LOC术后1年右侧卵巢超声检查图(白色箭头所示为卵巢)
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