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

doi:10.3877/cma.j.issn.1673-5250.2021.04.007

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
组别	例数	年龄(岁)	人体质量指数(kg/m²)	r-AFS评分(分)	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

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
组别	例数	年龄(岁)	人体质量指数(kg/m²)	r-AFS评分(分)	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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