腹腔镜卵巢囊肿剔除术中不同止血方式对卵巢女性激素水平的影响

目的探讨采用不同的止血方式行腹腔镜卵巢良性肿瘤剔除术对患者月经及性激素水平的近期影响。方法回顾分析2008年3月-2009年8月行腹腔镜下良性卵巢囊肿剔除术105例资料，按止血方式分为缝合组（镜下缝合止血47例）和电凝组（双极电凝止血，输出功率40-50w，58例）。观察2组手术时间、出血量、术后月经情况。术前、术后1个月、术后3个月、术后6个月抽血测定17B-雌二醇（E，）、促卵泡激素（FSH）、促黄体生成素（LH）水平。结果与电凝组相比，缝合组手术时间长[（65．2±23．7）rainvs．（40．6±20．5）min，t=5．701，P=0．000]，出血量多[（105．2±30．3）mlvs．（65．6±25．4）ml，t=7．285，P=0．000]。电凝组和缝合组各有2例和1例出现卵巢功能早衰（x^2=0．000，P=1．000）。2组术后1个月和3个月时，E2、FSH和LH水平差异无显著性（P〉0．05），但术后6个月，2组相比，电凝组E：水平降低、FSH和LH水平升高更显著[E：缝合组（341．5±43．8）ng／L，电凝组（246．5±52．5）ng／L，t=9．917，P=0．000；FSH缝合组（6．99±2．32）U／L，电凝组（9．05±2．61）U／L，t=-4．249，P=0．000；LH缝合组（11．33±3．11）U／L，电凝组（15．83±3．50）U／L，t=-6．891，P=0．ooo3。结论从术后激素测定的方面比较，腹腔镜下卵巢的缝合止血法和电凝止血法，在术后早期（3个月内）对卵巢功能的损害相近，但在6个月后，缝合止血法较电凝止血法对卵巢功能的损害小。

Influence of Intraoperative Hemostasis on the Hormone Level of Woman Undergone Laparoscopic Ovariectomy

Objective To investigate the influence of different ways of hemostasis during laparoscopic surgery for benign ovarian cyst on the menses and the levels of sex hormones. Methods From March 2008 to August 2009, 105 patients with benign ovarian cyst, who received ovariectomy by laparoscopy surgery in our hospital were enrolled into this study. We divided the patients into two groups according to the method of hemostasis： suture group （47 patients） and electric coagulation group （58 patients, bipolar, 40 - 50 W）. The operation time, intraoperative blood loss, postoperative menses, as well as the preoperative, and 1 , 3, and 6 months postoperative serum levels of 17β-E2, FSH, and LH were determined and compared between the two groups. Results Compared with the electronic coagulation group, the suture group had significantly longer operation time and more intraoperative blood loss [（65.2±23.7） min vs. （40.6±20.5） min, t=5.701, P=0.000; （105.2±30.3） mlvs. （65.6±25.4） ml, t=7.285, P= O. 000]. After the operation, premature ovarian failure was detected in two cases from the electric coagulation group, and one case form the suture group （X^2 = 0. 000, P = 1. 000）. The postoperative levels of 17β-E2, FSH, and LH did not show significant difference between the two groups at 1 and 3 months （P 〉 0.05） , however, at 6 months postoperation, the decrease of 17β-E2 , and increase of FSH and LH in the electric coagulation group were significantly more than those in the suture group [ suture group vs. electric coagulation group： E2： （341.5±43.8） ng/Lvs. （246.5 ±52.5） ng/L, t =9.917, P=0.000; FSH： （6.99±2.32） U/L vs. （9.05 ±2.61） U/L, t= -4.249, P=0.000; LH： （11.33±3.11） U/L vs. （15.83±3.50） U/L, t = -6.891, P=0.000]. Conclusions The damage of electric coagulation to the ovarian function is similar to that of suture hemostasis within 3 months postoperation; however, electric coagulation shows less influence on the ovarian function at 6 months than suture method.