两种微创术式行卵巢囊肿剥除的临床疗效对比分析

目的比较两种微创术式行卵巢囊肿剥除术的临床疗效,分析对卵巢储备功能的影响,探讨阴式手术治疗卵巢囊肿的临床价值。方法选取解放军总医院妇产科2014年1月~2016年12月诊治的卵巢囊肿患者208例,分为阴式组(采用阴式手术入路)和腹腔镜组(采用腹腔镜手术入路),比较两组手术相关指标和卵巢储备功能受损情况。结果阴式组纳入98例,腹腔镜组纳入110例。两组患者平均年龄、腹部手术史、囊肿直径、单双侧、囊肿类型差异无统计学意义(P>0.05)。阴式组手术时间(39.6±14.8)min少于腹腔镜组(52.2±25.6)min,住院费用(6654.2±340.7)元少于腹腔镜组(9532.8±1053.3)元,差异有统计学意义(P<0.001);两组术中出血量、平均住院天数差异无统计学意义(P>0.05)。阴式组手术前后雌二醇(E2)、卵泡刺激素(FSH)、卵泡刺激素/黄体生成素(FSH/LH)差异无统计学意义(P>0.05);术前卵巢窦卵泡数(AFC)(8.4±1.8)个多于术后(7.6±1.2)个,差异有统计学意义(P<0.001)。腹腔镜组手术前E2(149.4±32.5)pmol/L、FSH(8.1±3.0)U/L、FSH/LH(1.2±0.5)、AFC(8.7±1.9)个与术后E2(137.3±25.1)pmol/L、FSH(13.3±4.6)U/L、FSH/LH(1.7±0.6)、AFC(6.3±1.0)个相比,差异均有统计学意义(P<0.01)。结论与腹腔镜手术相比,阴式卵巢囊肿剥除术操作更直观,手术时间更少;阴式手术对卵巢功能影响小,住院费用少,对硬件要求低,适合基层医院开展。

Comparison of clinical efficacy and ovarian function of two kinds of minimally invasive ovarian cystectomy

Objective To compare the clinical value of two kinds of minimally invasive ovarian cystectomy and the effect on reserved ovarian function. To investigate the clinical value of transvaginal surgery of ovarian cystectomy. Methods A total of 208 cases of ovarian cystectomy in our hospital during January 2014 ~December 2016 were selected. The cases were divided two groups:98 cases in vaginal group (vaginal operation) and 110 cases in laparoscopic group (laparoscopic operation). The operation related indexes and ovarian reserved function were compared between the two groups. Results There was no significant difference in mean age,abdominal surgical history,cyst diameter,single bilateral,cyst type between the two groups (P>0.05). The operation time(39.6 ± 14.8 min) and hospitalization cost (6654.2 ± 340.7 yuan) of the vaginal group were less than those of the laparoscopic group (52.2 ± 25.6)min & (9532.8 ± 1053.3)yuan (P < 0.001). There was no significant difference between the vaginal group and the laparoscopic group in the amount of bleeding and average hospital stays (P > 0.05).There was no significant difference in E2,FSH and FSH/LH before and after operation in the vaginal group. The preoperative AFC value (8.4 ± 1.8) was more than postoperative (7.6 ± 1.2) (P < 0.001). In the laparoscopic group, the preoperative E2 (149.4 ± 32.5)pmol/L,FSH (8.1 ± 3.0)U/L,FSH/LH (1.2 ± 0.5),AFC value(8.7 ± 1.9) were compared with postoperative (137.3 ± 25.1)pmol/L & (13.3 ± 4.6)U/L&(1.7 ± 0.6),(6.3 ± 1.0), the difference was all statistically significant (P < 0.001). Conclusion Compared with laparoscopic surgery,vaginal ovarian cystectomy is more intuitive and has less operation time. Vaginal surgery has little influence on ovarian function ,low hospitalization cost and low hardware requirement,so it is suitable for primary hospital.