腹腔镜下卵巢良性肿瘤剔除术中不同止血方式对患者术后卵巢功能和妊娠结局的影响
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摘要
目的:探讨腹腔镜卵巢良性肿瘤剔除术中不同止血方式对患者术后卵巢功能和妊娠结局的影响。方法:选取2015年1月-2017年1月收治的120例良性卵巢肿瘤患者为研究对象,按照止血方式不同分为电凝组(行腹腔镜下双极电凝止血,n=62)和缝合组(行腹腔镜下缝合止血,n=58),观察并比较两组术后的卵巢功能以及妊娠结局。结果:术后1个月,两组的AMH、AFC、E_2均较术前下降,FSH均较术前上升,差异均有统计学意义(P<0.05)。术后3个月,缝合组的AMH、AFC、E_2、FSH与术前比较,差异均无统计学意义(P>0.05);电凝组的AMH、AFC、E_2均低于术前,差异均有统计学意义(P<0.05)。术后6个月,缝合组的AMH、AFC均较术前升高,且均显著高于电凝组(P<0.05);电凝组的AMH、AFC均显著低于术前(P<0.05)。缝合组术后1年内的妊娠率为68.97%(40/58),电凝组为59.68%(37/62),两组比较差异无统计学意义(X~2=1.124,P>0.05)。结论:腹腔镜下剔除卵巢良性肿瘤术中采用缝合止血最有利于保护卵巢功能,促进妊娠,宜作为近期有生育需求患者的首选手术方式。
Objective:To explore the influence of different hemostatic method to the ovarian function and the pregnancy outcome of the patients with benign ovarian tumor.Method:120 patients with benign ovarian tumor were selected as the objects from January 2015 to January 2017,according to different hemostasis methods,patients were divided into electrocoagulation group(laparoscopic bipolar electrocoagulation hemostasis,n=62)and suture group(laparoscopic suture hemostasis,n=58).The postoperative ovarian function and pregnancy outcome of the two groups were observed and compared.Result:One month after the operation,AMH,AFC and E_2 in both groups decreased compared with that before the operation,and FSH increased compared with those before the operation,with statistically significant differences(P<0.05).Three months after surgery,AMH,AFC,E_2 and FSH in the suture group were compared with those before surgery,the differences were not statistically significant(P>0.05);AMH,AFC and E_2 in the electrocoagulation group were lower than those before surgery,the differences were statistically significant(P<0.05).Six months after surgery,the AMH and AFC in the suture group were higher than those in the preoperative,and both were significantly higher than those in the electrocoagulation group(P<0.05);AMH and AFC in the electrocoagulation group were significantly lower than those before surgery(P<0.05).The pregnancy rate was 68.97%(40/58)in the suture group and 59.68%(37/62)in the electrocoagulation group within 1 year after surgery,with no statistically significant difference between the two groups( X~2=1.124,P>0.05).Conclusion:Laparoscopic hemostasis for the removal of benign ovarian tumors is the most conducive to the protection of ovarian function and the promotion of pregnancy,and should be the preferred surgical method for patients with recent fertility needs.
Objective:To explore the influence of different hemostatic method to the ovarian function and the pregnancy outcome of the patients with benign ovarian tumor.Method:120 patients with benign ovarian tumor were selected as the objects from January 2015 to January 2017,according to different hemostasis methods,patients were divided into electrocoagulation group(laparoscopic bipolar electrocoagulation hemostasis,n=62)and suture group(laparoscopic suture hemostasis,n=58).The postoperative ovarian function and pregnancy outcome of the two groups were observed and compared.Result:One month after the operation,AMH,AFC and E_2 in both groups decreased compared with that before the operation,and FSH increased compared with those before the operation,with statistically significant differences(P<0.05).Three months after surgery,AMH,AFC,E_2 and FSH in the suture group were compared with those before surgery,the differences were not statistically significant(P>0.05);AMH,AFC and E_2 in the electrocoagulation group were lower than those before surgery,the differences were statistically significant(P<0.05).Six months after surgery,the AMH and AFC in the suture group were higher than those in the preoperative,and both were significantly higher than those in the electrocoagulation group(P<0.05);AMH and AFC in the electrocoagulation group were significantly lower than those before surgery(P<0.05).The pregnancy rate was 68.97%(40/58)in the suture group and 59.68%(37/62)in the electrocoagulation group within 1 year after surgery,with no statistically significant difference between the two groups( X~2=1.124,P>0.05).Conclusion:Laparoscopic hemostasis for the removal of benign ovarian tumors is the most conducive to the protection of ovarian function and the promotion of pregnancy,and should be the preferred surgical method for patients with recent fertility needs.
引文
[1]宋艳亭,周克水.保留功能的卵巢良性肿瘤腹腔镜手术缝合技巧[J].腹腔镜外科杂志,2017,22(5):397-398.
[2]刘东妮.腹腔镜下卵巢肿瘤剥离止血对卵巢功能的影响[J].深圳中西医结合杂志,2015,52(22):25-26.
[3]宋菁华,张军,李斌.非气腹腹腔镜手术治疗妊娠合并卵巢良性肿瘤45例[J].中国微创外科杂志,2014,20(10):888-891.
[4]肖淑,郑新秋,欧海蔚,等.腹腔镜与开腹手术治疗老年良性卵巢肿瘤对患者免疫功能及神经内分泌功能的影响[J].海南医学院学报,2016,22(1):62-65.
[5]黎金凤,陈远平.经阴道和腹腔镜行良性卵巢肿瘤切除术患者免疫功能改变的临床意义[J].检验医学与临床,2012,9(2):145-147.
[6]杨红波,梁维经.腹腔镜卵巢良性肿瘤剔除术中不同止血方式对患者术后卵巢功能的影响[J].现代中西医结合杂志,2014,23(23):2538-2539.
[7]刘丽学,杨晓葵.腹腔镜下卵巢肿瘤剥除术不同止血方法对患者卵巢功能恢复的影响[J].西部医学,2014,26(5):553-555.
[8]赵维楠,陈淑霞.腹腔镜与开腹手术治疗卵巢良性肿瘤对患者卵巢功能及神经内分泌功能的影响[J].实用癌症杂志,2018,33(6):1014-1016.
[9]王霞.腹腔镜下卵巢囊肿剥除术的疗效观察及其对预后的影响分析[J].医药论坛杂志,2014,35(6):149-150.
[10]张静,李凤文.4种止血方式在腹腔镜下卵巢肿瘤剥除术后对卵巢功能的影响分析[J].河北医科大学学报,2014,14(6):645-649.
[11]顾光华.腹腔镜卵巢囊肿剥除术中双极电凝和缝合止血对卵巢功能的影响研究[J].中外医疗,2017,36(9):4-6,22.
[12]陈冰,刘佳,李春东,等.不同止血方法对腹腔镜下卵巢肿瘤剥除术后卵巢功能影响的临床对比研究[J].现代肿瘤医学,2015,23(8):1106-1108.
[13]尹龙燕,任丽华,崔嗣庚,等.腹腔镜下卵巢肿瘤剥除术中不同止血法的术后卵巢功能比较[J].中国现代医生,2014,52(34):11-13.
[14]洪威阳,胡敏.腹腔镜下卵巢囊肿剥除术前后抗苗勒氏管激素与基础促卵泡刺激素水平的变化与临床价值[J].中国内镜杂志,2015,21(12):1307-1310.
[15]吴海霞.不同护理方法对腹腔镜下行卵巢囊肿剥离术患者的效果对比[J].中国实用医药,2014,9(10):215-216.
[16]李静,胡奕芳,汤光贤.腹腔镜卵巢囊肿剔除术不同止血方式对卵巢良性肿瘤患者卵巢功能的影响研究[J].当代医学,2015,21(34):1-3.
[17]林丽,谢娟华,王伶俐,等.腹腔镜下卵巢囊肿剥除术不同止血方式对残留卵巢功能的影响[J].腹腔镜外科杂志,2016,21(4):304-307.
[18]韩晓霞,左瑞菊,马肖.窦卵泡计数、抗苗勒管激素与性激素检测评价卵巢储备的研究[J].中国医药导报,2017,14(18):117-120.
[19]Hadlow N,Brown S J,Habib A,et al.Quantifying the intraindividual variation of antimullerian hormone in the ovarian cycle[J].Fertil Steril,2016,106(5):1230-1237.
[20]Broer S L,Broekmans F J,Laven J S,et al.Ant-Müllerian hormone:ovarian reserve testing and its potential clinical implication[J].Hum Reprod Update,2014,20(5):688-701.
[21]邵一丹,梁元姣,陈莉,等.抗苗勒氏管激素下降率对多囊卵巢患者促排卵疗效的预测价值[J].医学研究生学报,2016,29(6):616-620.
[22]刘康生,王培,陈亚军.抗苗勒管激素与基础性激素相关性及其在孕前育龄女性中的应用价值[J].东南国防医药,2018,20(3):289-291.
[2]刘东妮.腹腔镜下卵巢肿瘤剥离止血对卵巢功能的影响[J].深圳中西医结合杂志,2015,52(22):25-26.
[3]宋菁华,张军,李斌.非气腹腹腔镜手术治疗妊娠合并卵巢良性肿瘤45例[J].中国微创外科杂志,2014,20(10):888-891.
[4]肖淑,郑新秋,欧海蔚,等.腹腔镜与开腹手术治疗老年良性卵巢肿瘤对患者免疫功能及神经内分泌功能的影响[J].海南医学院学报,2016,22(1):62-65.
[5]黎金凤,陈远平.经阴道和腹腔镜行良性卵巢肿瘤切除术患者免疫功能改变的临床意义[J].检验医学与临床,2012,9(2):145-147.
[6]杨红波,梁维经.腹腔镜卵巢良性肿瘤剔除术中不同止血方式对患者术后卵巢功能的影响[J].现代中西医结合杂志,2014,23(23):2538-2539.
[7]刘丽学,杨晓葵.腹腔镜下卵巢肿瘤剥除术不同止血方法对患者卵巢功能恢复的影响[J].西部医学,2014,26(5):553-555.
[8]赵维楠,陈淑霞.腹腔镜与开腹手术治疗卵巢良性肿瘤对患者卵巢功能及神经内分泌功能的影响[J].实用癌症杂志,2018,33(6):1014-1016.
[9]王霞.腹腔镜下卵巢囊肿剥除术的疗效观察及其对预后的影响分析[J].医药论坛杂志,2014,35(6):149-150.
[10]张静,李凤文.4种止血方式在腹腔镜下卵巢肿瘤剥除术后对卵巢功能的影响分析[J].河北医科大学学报,2014,14(6):645-649.
[11]顾光华.腹腔镜卵巢囊肿剥除术中双极电凝和缝合止血对卵巢功能的影响研究[J].中外医疗,2017,36(9):4-6,22.
[12]陈冰,刘佳,李春东,等.不同止血方法对腹腔镜下卵巢肿瘤剥除术后卵巢功能影响的临床对比研究[J].现代肿瘤医学,2015,23(8):1106-1108.
[13]尹龙燕,任丽华,崔嗣庚,等.腹腔镜下卵巢肿瘤剥除术中不同止血法的术后卵巢功能比较[J].中国现代医生,2014,52(34):11-13.
[14]洪威阳,胡敏.腹腔镜下卵巢囊肿剥除术前后抗苗勒氏管激素与基础促卵泡刺激素水平的变化与临床价值[J].中国内镜杂志,2015,21(12):1307-1310.
[15]吴海霞.不同护理方法对腹腔镜下行卵巢囊肿剥离术患者的效果对比[J].中国实用医药,2014,9(10):215-216.
[16]李静,胡奕芳,汤光贤.腹腔镜卵巢囊肿剔除术不同止血方式对卵巢良性肿瘤患者卵巢功能的影响研究[J].当代医学,2015,21(34):1-3.
[17]林丽,谢娟华,王伶俐,等.腹腔镜下卵巢囊肿剥除术不同止血方式对残留卵巢功能的影响[J].腹腔镜外科杂志,2016,21(4):304-307.
[18]韩晓霞,左瑞菊,马肖.窦卵泡计数、抗苗勒管激素与性激素检测评价卵巢储备的研究[J].中国医药导报,2017,14(18):117-120.
[19]Hadlow N,Brown S J,Habib A,et al.Quantifying the intraindividual variation of antimullerian hormone in the ovarian cycle[J].Fertil Steril,2016,106(5):1230-1237.
[20]Broer S L,Broekmans F J,Laven J S,et al.Ant-Müllerian hormone:ovarian reserve testing and its potential clinical implication[J].Hum Reprod Update,2014,20(5):688-701.
[21]邵一丹,梁元姣,陈莉,等.抗苗勒氏管激素下降率对多囊卵巢患者促排卵疗效的预测价值[J].医学研究生学报,2016,29(6):616-620.
[22]刘康生,王培,陈亚军.抗苗勒管激素与基础性激素相关性及其在孕前育龄女性中的应用价值[J].东南国防医药,2018,20(3):289-291.