单孔或三孔腹腔镜下卵巢成熟性囊性畸胎瘤剥除术对生育能力的影响比较

目的:探讨单孔和三孔腹腔镜下卵巢成熟性囊性畸胎瘤剥除术对生育能力的影响。方法:选取2013年5月-2015年5月本院收治的单侧卵巢成熟畸胎瘤患者120例,将其按照随机数字法随机分为单孔组和三孔组各60例。分别采用单孔或三孔腹腔镜下卵巢成熟性囊性畸胎瘤剥除术治疗,对两组术中、术后3个月采用B超测量卵巢体积,放射免疫法测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)水平,术后随访1年记录两组的妊娠率。结果:单孔组手术时间高于三孔组,但出血量低于三孔组(P0.05)。术后3个月手术侧的卵巢体积与未手术侧相比单孔组无差异(P0.05),三孔组手术侧体积小于未手术侧(P0.05)。两组未手术侧卵巢体积相比无差异(P0.05),但手术侧卵巢体积单孔组大于三孔组(P0.05)。术后3个月两组的FSH、LH均较术前上升,E_2较术前下降,但三孔组较单孔组FSH、LH上升更为明显、E_2下降更为明显(均P0.05)。单孔组1年后妊娠率高于三孔组,平均妊娠时间低于三孔组(P0.05)。结论:与三孔腹腔镜下卵巢成熟性囊性畸胎瘤剥除术相比,单孔可以有效避免对正常卵巢组织的损伤,对卵巢储备功能影响较小,且可提高妊娠率。

The influence of ovarian maturity of cystic teratoma enucleation using single hole or three holes laparoscopic on fertility

Objective:To explore the influence of ovarian maturity of cystic teratoma enucleation using single hole or three holes laparoscopicon fertility.Methods:From May 2013 to May 2015,120 patients with mature teratoma were selected and randomly divided into the group A and group B (60 cases in each group).The patients in group A had experienced teratoma enucleation by single hole laparoscopic,while patients in B group were treated by three holes laparoscopic.Ovarian volumeby ultrasound measurements,and serum follicle stimulating hormone (FSH),luteinizing hormone (LH) and estradiol (E2) levels by radioimmunoassay of patients in the two groups were observed during operation and at 3 months post operation.The pregnancy rate of patients after operation 1year was also compared between the two groups.Results:The operation time in the group A was significantly higher than that in the group B,but the amount of bleeding of patients was significantly lower than that of patients in the group B (P＜0.05).In group A,the volume of ovarian undergone surgery compared to another side ovarian without surgery had no significant difference after operation 3 months (P＞0.05),but in group B,the volume of ovarian undergone surgery was significantly smaller than that of ovarian without surgery (P＜0.05).And the volume of ovarian without surgery had no statistical significance between the two groups (P＞0.05),but volume of ovarian with surgery of patients in group A was significantly bigger than that of patients in group B (P＜0.05).The level of FSH and LH of patients in both groups after operation 3 months were all increased when compared to those of patients before operation,and the level of E2 decreased,but there were no significantly deference (P＞0.05).The level of FSH and LH of patients in group B increased significantly than those of group A (P＜0.05),and the level of E2 decreased more significantly (P＜0.05).The pregnancy rate of patients in group A was significantly higher than that of patients in group B,and the average gestation time of patients in group A was significantly lower than that of patients in group B (P＜0.05).Conclusion:Compared to ovarian mature cystic teratoma enucleation by three holes laparoscopic,operation by single hole laparoscopic can avoid to damage normal ovarian tissue effectively,can reduce the influence on the ovarian function,and can increase the pregnancy rate.