腹腔镜下卵巢囊肿剥除术后创面电凝和缝合止血对残留卵巢储备功能的影响

目的探讨腹腔镜下不同解剖位置卵巢囊肿剥除术后残留卵巢创面采用双极电凝和缝合止血方法对卵巢储备功能的影响。方法 2008年1月至2011年6月在川北医学院附属医院妇产科收治的双侧卵巢囊肿患者120例。随机分为电凝组(60例)和缝合组(60例)。比较两组不同解剖位置卵巢囊肿剥除术后的雌二醇(E2)、卵泡刺激素(FSH)、黄体生成激素(LH)以及窦卵泡计数(AFC)的变化情况。结果全部患者均顺利完成手术,术中未发生任何并发症;两组中位于卵巢门以外卵巢囊肿,术后雌二醇(E2)、FSH以及AFC比较差异无统计学意义(P>0.05);两组位于卵巢门附近的卵巢囊肿,电凝术后E2和AFC均显著下降,FSH显著升高,差异均有统计学意义(P<0.05);缝合术后的E2、FSH以及AFC差异无统计学意义(P>0.05);位于卵巢门附近的卵巢囊肿剥除术后采用电凝止血组术后卵巢功能衰竭病例发生5例,而采用缝合组没有卵巢功能衰竭发生。结论为保护残留卵巢功能,腹腔镜下卵巢囊肿剥离后的创面出血采用何种止血方式与囊肿的解剖位置有关。对于囊肿位于卵巢门部位外的,双极电凝简便易行,对残留卵巢功能影响小;而对于囊肿位于卵巢门部位的,应尽量采用缝合止血的方法,并注意缝合的深度。     

AMH在卵巢囊肿术后对卵巢储备影响的评价作用

目的:探讨AMH在腹腔镜卵巢囊肿剔除术中卵巢创面采用电凝或缝合止血方法对卵巢储备功能影响的评价作用。方法:选取2008年5月至2013年7月因单侧卵巢囊肿行腹腔镜下卵巢囊肿剔除术的38例患者,随机将患者分为缝合组(20例)、电凝组(18例),术中创面止血分别采用缝合法和电凝法。同时选取23例正常育龄妇女为对照组。于术前1个月及术后第1、3、6个月检测基础性激素水平(AMH、FSH、LH、E2),月经周期第3~5天行阴道彩色多普勒超声检查,检测卵巢间质动脉血流阻力指数(RI)及窦卵泡数(AFC)。结果:3组患者的术前一般情况和卵巢储备功能比较,差异均无统计学意义(P0.05)。与正常对照组比较,缝合组、电凝组囊肿侧卵巢术后1月的AFC明显减少,术后1、3、6月AMH水平明显下降,术后1月E2水平增高,差异均有统计学意义(P均0.05);缝合组、电凝组术后1、3、6月卵巢间质动脉RI、LH、FSH水平与正常对照组比较,差异均无统计学意义(P0.05)。结论:卵巢囊肿术后,AMH较其他评价卵巢储备的指标明显下降,在其他指标恢复术前水平后仍提示卵巢储备受损。提示AMH可用于临床评价卵巢储备。     

两种止血方法对卵巢子宫内膜异位囊肿术后卵巢储备功能的影响

目的探讨腹腔镜卵巢子宫内膜异位囊肿剥除术中创面采用二氧化碳激光消融止血、双极电凝止血两种不同的止血方法对卵巢储备功能的影响。方法选择2014年9月至2016年11月在上海市嘉定区妇幼保健院住院治疗的双侧卵巢子宫内膜异位囊肿患者128例,并随机分为两组,囊肿剥除术中采用二氧化碳激光消融术(研究组A组64例)、双极电凝止血(对照组B组64例);并于手术前、术后第1、3、6个月及12个月月经周期第3天查血FSH、LH及E2、超声测量双侧卵巢基础窦卵泡计数和卵巢体积等卵巢储备功能的指标。结果术后第1个月月经第3天两组LH、FSH水平、双侧卵巢基础窦卵泡计数、卵巢体积两组差异均无显著性(P0.05);术后第3个月、6个月及12个月A组LH、FSH水平均低于B组(P0.05),双侧卵巢基础窦卵泡计数、卵巢体积均大于B组(P0.05);术后第1、3、6个月及12个月,A组的E2水平均高于B组(P0.05)。结论腹腔镜卵巢子宫内膜异位囊肿剥除术中采用二氧化碳激光消融术对于卵巢储备功能的影响低于双极电凝组。     

腹腔镜卵巢巧克力囊肿剥除术电凝止血对卵巢储备功能的影响

目的:探讨腹腔镜下卵巢巧克力囊肿剥除术中创面采用电凝止血方法对术后卵巢功能的影响.方法:选取有腹腔镜手术适应证的卵巢巧克力囊肿患者39例,术中创面采用电凝法止血.于术前、术后及术后6个月抽血检测FSH、LH、E2及阴道B超探测窭状卵泡数(Fo)、卵巢间质动脉血流的收缩期峰值(PSV)以判断卵巢储备功能.结果:术后及术后6个月较术前的PSH显著升高(P<0.05),E2、Fo、PSV显著降低(P<0.01);患者术前基础内分泌指标、窦状卵泡数及PSH/LH的比值均在正常范围.术后检查共发现8例(24.2%)卵巢储备功能下降的患者.结论:腹腔镜下卵巢巧克力囊肿剥除术中电凝止血法易致卵巢储备功能降低.     

卵巢肿物剥除术不同止血方式对卵巢功能的影响

目的探讨卵巢肿物剥除术中使用可吸收线缝合、单、双极电凝及超声刀四种方式止血对卵巢功能的影响。方法共200例单侧卵巢良性肿瘤患者均行卵巢肿物剥除术,按不同止血方式分为超声刀组、单极电凝组、双极电凝组、可吸收线缝合组每组50例,分别于术前、术后1个月、术后3个月及术后6个月的月经周期第2~3天化验卵泡刺激素（FSH）、促黄体生成素（LH）、雌二醇（E2）,并行阴道彩超监测卵巢窦卵泡数（AFC）,同时随访术后6个月期间的月经变化。结果四组患者术前性激素、窦卵泡数及月经改变比较差异无统计学意义（P〉0.05）。术后1个月较术前均出现E2下降和FSH、LH增高及窦卵泡数减少,与术前比较差异均有统计学意义（P〈0.05）;术后3个月可吸收线缝合组激素水平基本恢复术前水平,其余三组较术前比较差异均有统计学意义（P〈0.05）,超声刀组E2水平偏高,FSH、LH水平偏低,与其余两组比较差异有统计学意义（P〈0.05）,可吸收线缝合组及超声刀组窦卵泡数恢复正常范围;术后6个月超声刀组激素水平基本恢复,但单极组、双极组E2、FSH、LH较术前比较差异仍有统计学意义（P〈0.05）,但较之术后1个月比较,E2有所升高,FSH、LH有所降低,差异有统计学意义（P〈0.05）。窦卵泡数较术前比较差异均无统计学意义（P〉0.05）。月经的改变主要表现为月经周期延长、月经量减少,偶有经期延长及轻微潮热出汗,情绪烦躁的表现,但在术后3~6个月间症状基本消失,并没有出现闭经及严重围绝经期症状的患者。结论卵巢肿物剥除术中可吸收线缝合对卵巢功能影响最小而恢复最快的。超声刀组较高频电刀组（单极、双极）恢复快,影响小。     

腹腔镜卵巢子宫内膜异位囊肿剥除术对卵巢储备功能的影响

目的:探讨腹腔镜卵巢子宫内膜异位囊肿(巧囊)剥除术对卵巢储备功能可能造成的影响。方法:前瞻性对照研究,对照组:单侧卵巢成熟性囊性畸胎瘤行腹腔镜囊肿剥除术20例;实验组:卵巢子宫内膜异位囊肿行腹腔镜囊肿剥除术80例。实验组分为4组:A组:单侧巧囊35岁(27例),B组:单侧巧囊≥35岁(13例),C组:双侧巧囊35岁(28例)和D组:双侧巧囊≥35岁(12例)。比较各组手术前、手术后24h内血清FSH,LH,E2的变化并根据单侧巧囊的大小和类型分层分析。随访患者术后6月基础FSH的恢复情况,术后6月超声测量患者双侧卵巢的体积。结果:双侧各组(C,D两组)卵巢子宫内膜异位囊肿剥除术后24h内FSH较术前明显增高(P0.05),E2明显减低(P0.05),LH变化不明显。畸胎瘤组及单侧各组(A,B组)手术前后各激素水平均无统计学差异,分层分析单侧巧囊大小和类型,各组内组间激素水平变化亦无明显差异。C组患者术后6月基础FSH恢复至正常范围内占72.22%,而D组患者基础FSH恢复至正常范围内仅占55.56%,差异有统计学意义(P0.05)。单侧卵巢囊肿剥除术后6月患侧与对侧卵巢缩小率均有显著差异(P0.05),单侧卵巢囊肿剥除术后与双侧卵巢囊肿剥除术后患侧卵巢缩小率无统计学差异。结论:腹腔镜双侧卵巢子宫内膜异位囊肿剥除术对卵巢储备功能有一定的影响,但大部分患者可在术后6个月内恢复。     

腹腔镜下卵巢囊肿切除术中电凝和缝合止血对卵巢储备功能影响的Meta分析

目的探讨腹腔镜下卵巢囊肿切除术中电凝止血及缝合止血方式对卵巢储备功能的影响。方法纳入腹腔镜下卵巢囊肿切除术患者的随机对照试验(RCT),其中术中行缝合止血者为缝合组,行电凝止血者为电凝组。由两名评估员独立筛查文献,进行质量评价和资料提取。使用Cochrane协作网提供的RevMan 5.2软件进行Meta分析。结果共19个腹腔镜下卵巢囊肿切除术的RCT符合纳入标准。Meta分析结果显示,电凝组抗苗勒管激素(RR=0.58,95%CI:0.36~0.81,P0.001)、E2(RR=2.93,95%CI:1.92~3.94,P0.001)、卵巢间质动脉血流收缩期峰值(RR=0.90,95%CI:0.57~1.23,P0.001)水平较缝合组低;电凝组窦卵泡数(RR=1.89,95%CI:1.22~2.56,P0.001)较缝合组少;电凝组FSH高于缝合组(RR=-1.38,95%CI:-2.11~-0.65,P0.001);电凝组LH(RR=-0.41,95%CI:-1.19~0.38,P0.05)、卵巢大小(RR=2.77,95%CI:-0.54~6.07,P0.05)与缝合组比较,差异无统计学意义(P0.05)。结论腹腔镜下卵巢囊肿切除术后可能造成卵巢储备功能下降,对卵巢创面出血的处理中,电凝止血法导致卵巢储备功能下降较缝合止血法明显,但需要更多的高质量研究证实。     

经脐单孔腹腔镜与传统腹腔镜手术治疗卵巢囊肿的疗效对比分析

目的:分析经脐单孔腹腔镜与传统腹腔镜行卵巢囊肿剥除术的临床效果差异及对卵巢储备功能的影响。方法:选择2018年5月至2020年7月我院因卵巢囊肿行囊肿剥除术患者共173例,分为观察组(经脐单孔腹腔镜手术组)82例、对照组(传统腹腔镜手术组)91例,比较两组的术中及术后情况,包括手术时间、术中出血量、卵巢囊肿腹腔内破裂情况、术后肛门排气时间、术后住院时间、手术并发症及术后24小时疼痛视觉模拟评分(VAS)、术后3个月患者切口美观满意度评分,同时比较两组术前、术后卵巢储备情况,包括抗苗勒管激素(AMH)、黄体生成素(LH)、卵泡刺激素(FSH)及窦卵泡计数(AFC)。结果:观察组术后肛门排气时间缩短、术后住院时间减少,术后24小时VAS降低、术后切口美观满意度评分升高,两组差异有统计学意义(P<0.05);两组手术时间、术中出血量、卵巢囊肿腹腔内破裂率差异无统计学意义(P>0.05);两组术后1个月AMH均较术前降低,LH、FSH较术前升高,差异有统计学意义(P<0.05);术后3个月血清AMH、LH、FSH水平及AFC数目与术前差异无统计学意义(P>0.05),两组间比较差异无统计学意义(P>0.05)。结论:单孔腹腔镜手术在卵巢囊肿剔除术中可以减轻患者术后疼痛、促进术后快速康复、提高患者术后满意度,并且对卵巢储备功能影响不劣于传统腹腔镜手术。     

腹腔镜下卵巢囊肿剥除术联合醋酸戈舍瑞林治疗卵巢巧克力囊肿疗效及对卵巢功能的影响

目的 探讨腹腔镜下卵巢囊肿剥除术联合醋酸戈舍瑞林治疗卵巢巧克力囊肿的临床效果。方法 选取84例卵巢巧克力囊肿患者,根据随机数字表法分为对照组与试验组,每组42例。对照组采用腹腔镜下卵巢囊肿剥除术治疗,试验组采用腹腔镜下卵巢囊肿剥除术联合醋酸戈舍瑞林治疗。比较两组手术前后卵巢功能、术后半年疼痛情况及治疗效果。结果 手术前,两组卵泡刺激素(FSH)、雌二醇(E₂)、促黄体生成素(LH)及抗苗勒管激素(AMH)水平比较,差异无统计学意义(P>0.05);手术后,试验组FSH、E₂及LH水平均低于对照组,AMH水平高于对照组,差异有统计学意义(P<0.05)。手术前,两组性交痛、痛经及盆腔痛评分比较,差异无统计学意义(P>0.05);试验组患者术后半年性交痛、痛经及盆腔痛评分均低于对照组,差异有统计学意义(P<0.05)。试验组治疗总有效率97.62%显著高于对照组的78.57%,差异有统计学意义(P<0.05)。结论 针对卵巢巧克力囊肿患者采取腹腔镜下卵巢囊肿剥除术联合醋酸戈舍瑞林治疗可改善患者卵巢功能,缓解机体疼痛,...     

不同止血方法对双侧卵巢储备功能的影响

目的探讨不同止血方法对双侧卵巢储备功能的影响。方法选取我院2013年8月~2014年9月收治的卵巢子宫内膜异位囊肿患者78例,将其随机分为A组与B组,各39例。两组患者均行常规腹腔镜卵巢子宫内膜异位囊肿剥除术,A组采取超声刀止血,B组采取缝合止血。对两组患者术后窦卵泡计数(AFC)与促卵泡性腺激素(FSH)水平进行记录与分析,同时比较两组患者术后2年的自然妊娠情况。结果两组患者术后1个月、6个月及1年时的FSH水平较治疗前均有所升高,且B组与A组比较,差异有统计学意义(P0.05);B组术后6个月、1年时的AFC水平显著高于A组,差异有统计学意义(P0.05);B组患者的自然妊娠率显著高于对照组,差异有统计学意义(P0.05)。结论对于卵巢子宫内膜异位囊肿患者来说,在行腹腔镜剥除术时通过超声刀止血会影响到患者的卵巢储备功能,从而影响其自然妊娠能力,而缝合法对患者卵巢储备功能影响相对较小,安全性高,值得临床推广。     

Comparison of the effects of laparoscopic bipolar electrocoagulation and intracorporeal suture application to ovarian reserve in benign ovarian cysts

Purpose

Aim of the present study is to determine the effects of bipolar electrocoagulation and intracorporeal suture on the ovarian reserve after ovarian cystectomy.

Methods

Sixty patients aged 18–42 years old and with a persistent adnexal mass were recruited to the study. Patients were randomized into suture hemostasis group or bipolar hemostasis group. Laparoscopic ovarian cystectomy was performed to all patients. Hemostasis was obtained by bipolar coagulation in 30 patients and by intracorporeal sutures in 30 patients. Serum levels of FSH, LH, estradiol, inhibin B and ultrasonographic measurements (antral follicle count and ovarian volume) were analyzed and recorded at day 3 of menstrual cycle, 1 and 3 months after the surgery.

Results

Basal FSH level measurement at the postoperative third month was significantly increased to 6.96 ± 1.86 mIU/ml (p < 0.05) in the bipolar electrocoagulation group. However, the decreased ovarian volume and antral follicle count was restored at the postoperative third month in the bipolar electrocoagulation group. Preoperative and postoperative FSH, LH, estradiol and inhibin B levels and ultrasonographic measurements were similar in the intracorporeal suture group.

Conclusion

The unwanted effect of bipolar electrocoagulation on ovarian reserve is probably transient and causes minimal damage to ovary. FSH levels may be slightly elevated. Gentle use of bipolar electrocoagulation or intracorporeal are not found to effect ovarian reserve.     

地诺孕素、亮丙瑞林辅助治疗卵巢子宫内膜异位囊肿的临床效果比较#br#

Objective?To compare the efficacy of different drugs in adjuvant treatment of ovarian endometrioma. Methods?A total of 170 patients with ovarian endometriosis cysts were randomly divided into dienogest group (dienogest treatment) and leuprolide group (leuprolide treatment), 85 cases in each group. The curative effects of the two groups were compared, and the follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), carbohydrate antigen 125 (CA125), endometrial thickness, uterine volume, and antral follicle count (AFC) were observed in the two groups, ovarian stromal blood flow resistance index (RI), pulsatility index (PI) changes. Results?There was no significant difference in the total effective rate, endometrial thickness, uterine volume, CA125 level and AFC between the two groups (P>0.05); the levels of FSH, E2, LH, RI, and PI in the leuprolide group were lower than those in the dinoflagellate group. There was no significant difference in endometrial thickness, uterine volume, CA125 or AFC between the two groups after treatment (P＞0.05). After treatment, RI in leuprolide group was lower than that in dienogest group (P<0.05). Conclusion?The effects of dienogest and leuprolide on ovarian endometrioma cysts are similar, but adjuvant leuprolide therapy can be more beneficial to improve ovarian blood supply.     

Assessment of ovarian reserve as an indicator of fertility and health consequences in patients with chronic kidney disease stages 3–4

Abstract

The aim of the study was to evaluate whether ovarian reserve depends on chronic kidney disease. Twenty-four patients, 23–45?years with chronic kidney disease (CKD) stages 3–4 were included in the study. All the patients underwent transvaginal ultrasounds to assess antral follicle count (AFC) and ovarian volume. The serum samples were obtained on days 3–5 of the menstrual cycle from all participants for anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH), and estradiol (E2) levels. On the base of the study, it was concluded that the most sensitive parameters of ovarian reserve are AMH and AFC. AMH levels and number of antral follicles in both ovaries were statistically significantly lower in the group of patients with CKD than in control ones. But there were no significant differences in the ovarian volumes (right and left ovary), FSH and E2 levels between study and control groups. Ovarian reserve is not dependent on the duration of CKD and hormonal parameters of ovarian reserve like FSH and estradiol (E2) are not dependent on the presence or absence of proteinuria in patients with CKD, but the most sensitive parameter – AMH is significantly lower in patients with CKD and proteinuria.     

Hemostasis by Bipolar Coagulation Versus Suture After Surgical Stripping of Bilateral Ovarian Endometriomas: A Randomized Controlled Trial

Study objectiveTo estimate whether the suture of the ovary is superior to bipolar coagulation in preserving ovarian reserve in infertile women undergoing laparoscopic stripping of bilateral endometriomas.DesignRandomized controlled trial (Canadian Task Force classification I).SettingUniversity teaching hospital.Patients100 patients with bilateral endometriomas.InterventionsPatients underwent stripping of bilateral endometriomas and were randomized to undergo hemostasis by use of either laparoscopic suturing (LS group) or bipolar coagulation (BC group). Changes in ovarian reserve were investigated by measuring the levels of anti-Mullerian hormone (AMH) and basal follicle-stimulating hormone (FSH) before surgery and at 3, 6 and 12 months from surgery.Measurements and Main ResultsAt 3-month, 6-month, and 12-month follow-up, in both study groups, postsurgical AMH levels were significantly lower and basal FSH levels were significantly higher than before surgery. There was no significant difference in the mean percentage decrease of AMH levels in the BC group and LS group at 3-, 6-, and 12-month follow-up. The mean percentage increase in basal FSH was higher in the BC group than in the LS group at both 3-month (p = .023) and 6-month follow-up (p = .029), but not at 12-month follow-up. Pregnancy rate, time to conception, and rate of endometrioma recurrence was similar in the 2 study groups.ConclusionLaparoscopic stripping of ovarian endometriotic cyst significantly decreases serum AMH levels and increases basal FSH levels independent from the method used to obtain hemostasis on the ovarian tissue.     

Bipolar electrocoagulation versus suture of solitary ovary after laparoscopic excision of ovarian endometriomas

STUDY OBJECTIVE: To compare the functional ovarian damage associated with the use of bipolar coagulation versus ovarian suture after laparoscopic excision of ovarian endometriomas in patients with a solitary ovary. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Tertiary care center. PATIENTS: Forty-seven consecutive women with a single ovary and regular menses who underwent laparoscopic stripping of one or more ovarian endometriomas between June 1996 and June 2001. Intervention. Twenty-one patients had bipolar electrocoagulation (group A), while 26 had suturing of the ovary (group B). Plasma follicle-stimulating hormone (FSH) and estradiol levels were determined before surgery and re-evaluated at 3-, 6-, and 12-month follow-up. MEASUREMENTS AND MAIN RESULTS: At 12-month follow-up, six patients (29%) in group A had oligo-amenorrhea versus three patients (12%) in group B (p = .14). Follicle-stimulating hormone levels between 10 and 20 mlU/mL were found in five patients (24%) in group A and in three patients (12%) in group B, whereas FSH levels above 20 mlU/mL were found in three patients (14%) in group A and in no patient in group B. Eight patients (38%) in group A had FSH levels greater than 10 mlU/mL versus three patients (12%) in group B (p = .042). Overall, repeated analysis of variance showed a marginally significant difference (p = .06) in FSH values between the two groups. CONCLUSION: Our results suggest that bipolar electrocoagulation of the ovarian parenchyma after laparoscopic stripping of an endometriotic ovarian cyst adversely affects ovarian function.     

达英-35预防环磷酰胺对大鼠卵巢功能损伤的实验研究

目的:研究口服避孕药达英-35在雌性大鼠中减轻环磷酰胺(CTX)诱导的性腺毒性的效果。方法:随机将75只雌性Wistar大鼠分为5组:空白对照组、CTX组、达英-35组、联合治疗Ⅰ组和联合治疗Ⅱ组。用放射免疫法测定各组雌二醇(E2)和卵泡刺激素(FSH)水平,并于停药当天、第15天、30天,处死各组1/3的大鼠,比较卵巢重量、卵泡数量变化。结果:停药第30天,CTX组大鼠E2为(21.88±2.10)pg/ml,明显低于两个联合治疗组,FSH为(7.05±0.18)mIU/ml,明显高于两个联合治疗组,差异均有统计学意义(P0.05);CTX组卵巢重量和卵泡总数分别为(32.40±5.55)mg和308±32个,明显低于两个联合治疗组,差异有统计学意义(P0.05);联合治疗Ⅰ、Ⅱ组的E2、FSH、卵巢重量、卵泡数量分别比较,差异无统计学意义(P0.05)。结论:达英-35降低了CTX对大鼠卵巢功能的损伤,对卵巢功能的保护和恢复起到了一定的作用。     

人工流产术后继发性不孕原因分析及对女性性激素的影响

目的 研究分析人工流产术后继发性不孕原因及对女性性激素的影响.方法 选取46例行人工流产术后继发性不孕患者为研究组;另选同期40例人工流产术后正常受孕者为对照组.分析继发性不孕影响因素以及对女性性激素的影响.结果 两组患者年龄、手术方法、流产次数以及月经不调发生率比较,差异无统计学意义(P＞0.05),而宫腔粘连、慢性...