腹腔镜下卵巢子宫内膜异位囊肿剔除术对卵泡丢失的影响
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摘要
目的分析采用不同手术方式行腹腔镜下卵巢子宫内膜异位(EMs)囊肿剔除术对卵泡丢失的影响。方法我院2013年1月至2016年1月收治的86例行腹腔镜单侧卵巢EMs囊肿剔除术的患者,将其随机分为2组,对照组采用传统的钝性撕拉法,观察组采用改良的锐性分离法;观察囊壁标本的卵巢门附近、中间部位及卵巢窝处的标本厚度、存在卵巢皮质的标本数、存在卵巢皮质的厚度及卵巢皮质分级,并比较2种手术方式对卵巢功能及卵泡丢失的影响。结果卵巢门附近的剥离标本厚度明显大于卵巢窝处及中间部位的标本(t=4.474、t=3.520,P<0.001);卵巢窝处的皮质厚度要明显小于中间部位及卵巢门附近(t=1.705、t=4.428,P=0.046、P=0.000);卵巢门附近剥离的标本囊壁皮质分级达到3~4级的有20个,明显多于卵巢窝处的2个及中间部位的2个(χ~2=19.790、χ~2=19.790,P<0.001);观察组剥离的囊壁中间部位的标本厚度及存在的卵巢皮质厚度小于对照组(t=3.897、t=2.166,P=0.000、P=0.017);观察组剥离的囊壁卵巢门附近存在卵巢皮质的标本数显著少于对照组(χ~2=5.512,P=0.019),且标本厚度和存在的卵巢皮质厚度明显小于对照组(t=4.992、t=2.349,P=0.000、P=0.011);2组患者术后FSH、LH、E2等激素水平差异无统计学意义(P>0.05),但观察组患侧卵巢的窦卵泡数和卵巢体积均明显大于对照组(t=7.181、t=10.921,P<0.00 001);观察组患者术后的妊娠率达60.0%,明显高于对照组的43.75%(χ~2=5.289,P=0.021)。结论腹腔镜下卵巢EMs囊肿剔除术在剔除囊壁卵巢门附近时会丢失较多正常卵巢组织,改良锐性分离法可减少正常卵泡丢失,对卵巢功能影响小。
Objective To analyze the clinical effect of laparoscopic ovarian endometriosis( EMs) cyst resection and the influence of different operative methods on follicle loss. Methods Selected 86 EMs patients with laparoscopic ovarian cyst resection in our hospital from January 2013 to January 2016 and randomly divided them into two groups. The control group adopted traditional blunt tearing method,while the observation group adopted sharp isolating method. The specimen thickness along with the number,thickness and grading of specimen with ovarian cortex at hilus orarii,middle part of ovarian fossa and ovarian fossa were observed. Meanwhile,the influence on ovarian function and follicle loss of the two operation methods were compared. Results The specimen thickness close to the hilus orarii was more than that of the ovarian fossa and the middle part of ovarian fossa( t = 4. 474,t = 3. 520,P < 0. 001). The thickness of specimen with ovarian cortex at ovarian fossa was significantly less than that of the middle part of ovarian fossa and the hilus orarii( t = 1. 705,t = 4. 428,P = 0. 046,P = 0. 000). The number of specimen ovarian cortex grading of 3 to 4 at hilus orarii was 20,which was significantly more than 2 at the ovarian fossa and 2 at the middle part( χ~2= 19. 790,χ~2= 19. 790,P < 0. 001). The specimen thickness and ovarian cortical thickness of the middle part of the observation group were less than those of the control group( t = 3. 897,t = 2. 166,P = 0. 000,P = 0. 017). The specimen number of ovarian cortex at the hilus orarii was significantly less than the control group( χ~2= 5. 512,P = 0. 019),and the specimen thickness and the ovarian cortex thickness were obviously less than those of the control group( t = 4. 992,t = 2. 349,P = 0. 000,P = 0. 011). After operation,the differences between FSH,LH,and E2 levels in the two groups were not statistically significant( P > 0. 05),but the ovarian sinus follicle number and ovarian volume of the observation group were significantly more than those of the control group( t = 7. 181,t = 10. 921,P < 0. 00 001). The pregnancy rate of the observation group was 60. 0%,which was significantly higher than 43. 75% of the control group( χ~2= 5. 289,P = 0. 021).Conclusion The laparoscopic ovarian EMs cyst resection can cause the great loss of follicle in the progress of resecting cyst at hilus orarii,and advanced sharp separation can obviously reduce the loss of normal ovarian follicles and cause smaller influence on ovarian function.
Objective To analyze the clinical effect of laparoscopic ovarian endometriosis( EMs) cyst resection and the influence of different operative methods on follicle loss. Methods Selected 86 EMs patients with laparoscopic ovarian cyst resection in our hospital from January 2013 to January 2016 and randomly divided them into two groups. The control group adopted traditional blunt tearing method,while the observation group adopted sharp isolating method. The specimen thickness along with the number,thickness and grading of specimen with ovarian cortex at hilus orarii,middle part of ovarian fossa and ovarian fossa were observed. Meanwhile,the influence on ovarian function and follicle loss of the two operation methods were compared. Results The specimen thickness close to the hilus orarii was more than that of the ovarian fossa and the middle part of ovarian fossa( t = 4. 474,t = 3. 520,P < 0. 001). The thickness of specimen with ovarian cortex at ovarian fossa was significantly less than that of the middle part of ovarian fossa and the hilus orarii( t = 1. 705,t = 4. 428,P = 0. 046,P = 0. 000). The number of specimen ovarian cortex grading of 3 to 4 at hilus orarii was 20,which was significantly more than 2 at the ovarian fossa and 2 at the middle part( χ~2= 19. 790,χ~2= 19. 790,P < 0. 001). The specimen thickness and ovarian cortical thickness of the middle part of the observation group were less than those of the control group( t = 3. 897,t = 2. 166,P = 0. 000,P = 0. 017). The specimen number of ovarian cortex at the hilus orarii was significantly less than the control group( χ~2= 5. 512,P = 0. 019),and the specimen thickness and the ovarian cortex thickness were obviously less than those of the control group( t = 4. 992,t = 2. 349,P = 0. 000,P = 0. 011). After operation,the differences between FSH,LH,and E2 levels in the two groups were not statistically significant( P > 0. 05),but the ovarian sinus follicle number and ovarian volume of the observation group were significantly more than those of the control group( t = 7. 181,t = 10. 921,P < 0. 00 001). The pregnancy rate of the observation group was 60. 0%,which was significantly higher than 43. 75% of the control group( χ~2= 5. 289,P = 0. 021).Conclusion The laparoscopic ovarian EMs cyst resection can cause the great loss of follicle in the progress of resecting cyst at hilus orarii,and advanced sharp separation can obviously reduce the loss of normal ovarian follicles and cause smaller influence on ovarian function.
引文
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[2]闫志强,于春玲,莫培晖,等.卵巢子宫内膜异位囊肿剥除术中使用垂体后叶素注射对卵巢储备功能的影响[J].局解手术学杂志,2015,24(4):437-439.doi:10.11659/jjssx.11E014029.
[3]李素萍.腹腔镜手术治疗卵巢子宫内膜异位囊肿临床研究[J].中国妇幼保健,2013,28(32):5379-5380.
[4]周丹,刘嘉茵.不同药物辅助治疗腹腔镜术后卵巢子宫内膜异位症囊肿患者的效果观察[J].中国医药导报,2013,10(21):104-105.doi:10.3969/j.issn.1673-7210.2013.21.034.
[5]何剑芬,胡红波.开腹手术和腹腔镜手术治疗卵巢子宫内膜异位囊肿疗效对比分析[J].河北医学,2014,42(10):1699-1701.doi:10.3969/j.issn.1006-6233.2014.10.042.
[6]杨瑶,张平,刘红.腹腔镜双侧卵巢子宫内膜异位囊肿剔除术对卵巢储备功能及生育的影响[J].中国妇幼保健,2015,30(13):2116-2117.doi:10.7620/zgfybj.j.issn.1001-4411.2015.13.54.
[7]叶远征,王彦红,何艳,等.腹腔镜不同术式治疗卵巢子宫内膜异位囊肿疗效及安全性的系统评价[J].中国循证医学杂志,2013,13(1):55-61.doi:10.7507/1672-2531.20130012.
[8]郑爱梅,刘曼华.卵巢子宫内膜异位囊肿腹腔镜剥离术中不同止血方法对卵巢功能的影响[J].临床和实验医学杂志,2016,15(20):1990-1993.doi:10.3969/j.issn.1671-4695.2016.20.008.
[9]佟海燕,刘丽娜.不同腹腔镜术式治疗卵巢子宫内膜异位囊肿临床对比分析[J].中国性科学,2014,23(9):32-34.doi:10.3969/j.issn.1672-1993.2014.09.012.
[10]张香玲,韩敏,秦智敏.腹腔镜卵巢子宫内膜异位囊肿剥除术中不同止血方法对卵巢储备功能的影响[J].中国医学装备,2015,12(8):88-91.doi:10.3969/J.ISSN.1672-8270.2015.08.028.
[11]王丹丹,杨清.腹腔镜卵巢子宫内膜异位囊肿两种剥除方法对卵巢储备功能的影响[J].中国医科大学学报,2013,42(6):561-563.doi:10.3969/j.issn.0258-4646.2013.06.022.
[12]叶丽虹,方雅琴,田国琴,等.腹腔镜卵巢子宫内膜异位囊肿剥除术联合使用GnRH-a对卵巢储备功能的影响[J].现代妇产科进展,2014,23(3):171-174.doi:10.13283/j.cnki.xdfckjz.2014.03.003.
[13]刘恋,于永斌,万金华,等.卵巢内异症囊肿病灶的解剖特征及其与疼痛症状的相关性研究[J].局解手术学杂志,2014,23(5):537-538.doi:10.11659/jjssx.1672-5042.201405032.
[14]孙海萍.腹腔镜手术联合术后药物治疗中、重度卵巢子宫内膜异位囊肿合并不孕的临床分析[J].中国妇幼保健,2013,28(30):5000-5002.doi:10.7620/zgfybj.j.issn.1001-4411.2013.28.30.
[15]Georgievska J,Sapunov S,Cekovska S,et al.Ovarian reserve after laparoscopic treatment of unilateral ovarian endometrioma[J].Acta Inform Med,2014,22(6):371-373.doi:10.5455/aim.2014.22.371-373.
[16]王晓菊.腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿的对比研究[J].中国药物与临床,2014,14(3):360-361.doi:10.11655/zgywylc2014.03.039.
[17]徐叶芳,韩璐,郭凤,等.中重度卵巢型子宫内膜异位囊肿腹腔镜保守性手术后辅助促性腺激素释放激素类似物治疗的临床疗效分析[J].中国医师进修杂志,2014,37(21):26-29.doi:10.3760/cma.j.issn.1673-4904.2014.21.009.
[18]Georgievska J,Sapunov S,Cekovska S,et al.Effect of two laparoscopic techniques for treatment of ovarian endometrioma on ovarian reserve[J].Med Arch,2015,69(2):88-90.doi:10.5455/medarh.2015.69.88-90.
[19]何金慧.腹腔镜治疗卵巢子宫内膜异位囊肿疗效观察[J].河北医药,2014,17(3):363-364.doi:10.3969/j.issn.1002-7386.2014.03.017.
[20]蒋太芬.腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿的比较[J].重庆医学,2013,42(35):4335-4336.doi:10.3969/j.issn.1671-8348.2013.35.043.
[21]李晓,何云渝.两种腹腔镜卵巢子宫内膜异位囊肿剥除方法对卵巢储备功能的影响[J].中国妇幼保健,2015,30(1):158-160.doi:10.7620/zgfybj.j.issn.1001-4411.2015.01.59.