腹腔镜卵巢子宫内膜异位症囊肿剥除术中不同止血方法对患者卵巢储备功能的影响

目的：探讨腹腔镜下卵巢子宫内膜异位症囊肿(OEMC)剥除术中采用不同止血方法对患者卵巢储备功能的影响。方法选取2014年8月至2015年8月我院妇科收治的126例OEMC患者为研究对象，均行腹腔镜手术，且采用随机、单盲法将其分为三组各42例，术中分别采用不同的止血方法，即A组采用双极电凝止血，B组采用缝合止血，C组采用垂体后叶素注射止血。于术前、术后分别检测3组患者的血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平，阴道超声检测窦状卵泡数目(AFC)、卵巢间质动脉血流的收缩期峰值(PSV)，以判断患者卵巢储备功能。结果 B组、C组患者术后FSH、E2、LH水平与术前比较差异均无统计学意义(P>0.05)；而A组患者术后FSH水平为(13.67±1.83) U/L，与术前的(8.41±1.58) U/L比较明显升高，E2水平为(142.78±16.29) pmol/L，与术前的(189.65±20.16) pmol/L比较明显下降，差异均有统计学意义(P<0.05)，而LH水平与术前比较差异无统计学意义(P>0.05)；B组、C组患者术后AFC、PSV与术前比较差异均无统计学意义(P>0.05)，而A组患者术后AFC为(4.16±1.21)个、PSV为(5.86±1.38) cm/s，分别与术前的(9.25±1.18)个、(12.65±2.19) cm/s比较均明显减少，差异均有统计学意义(P<0.05)。结论腹腔镜下卵巢子宫内膜异位症囊肿剥除术中采用双极电凝止血法易导致患者卵巢储备功能下降，因此临床推荐使用缝合法止血和垂体后叶素注射止血。

Effect of different hemostasis methods on ovarian reserve function in patients with laparoscopic ovarian endometriosis cyst

Objective To investigate the effect of different methods of hemostasis on ovarian reserve function in patients with ovarian endometriosis cyst (OEMC). Methods A total of 126 patients of OEMC, who admitted to our hospital and underwent laparoscopic surgery from August 2014 to August 2015, were divided into three groups by randomized single blind method, with 42 cases in each group. The three groups (group A, group B and group C) were respectively treated by bipolar coagulation hemostasis, suture hemostasis and pituitrin injection hemostasis. In order to judge the ovarian reserve function, serum follicle stimulating prime (FSH), luteinizing prime (LH), estradiol (E2), transvaginal ultrasound detection of sinus follicular number (AFC), ovarian artery blood flow peak systolic ve-locity (PSV) were detected at the preoperative and postoperative. Results Compared with preoperative, the postop-erative levels of FSH, E2, LH in group B and group C showed no significant difference (P>0.05);while in group A, the postoperative level of FSH (13.67±1.83) U/L was significantly higher than the preoperative level (8.41±1.58) U/L (t=6.62, P<0.05), and the postoperative level of E2 (142.78±16.29) pmol/L was significantly lower than the preoperative level (189.65±20.16) pmol/L (P<0.05), with no significant change for LH (P>0.05). The postoperative levels of AFC and PSV of group B and group C patients showed no significant difference with the preoperative level (P>0.05); while in group A, the postoperative levels of AFC (4.16±1.21) and PSV (5.86±1.38) cm/s were significantly lower than the preop-erative levels (P<0.05). Conclusion Bipolar coagulation hemostasis method is prone to cause the decline of ovarian reserve function in patients with OEMC, so suture hemostasis and pituitrin injection hemostasis are worthy of clinical promotion.