Zhang Jun, Zhou Ying-fang, Li Bin, Jian Ping, Xiao Yu
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Aug;44(8):583-7.
To investigate the influence on ovarian reserve function in treatment of ovarian endometriotic cyst by laparoscopic cystectomy with various hemostasis management.
From September 2007 to August 2008, 61 patients with bilateral ovarian endometriotic cyst in Peking University First Hospital and Anzhen Hospital Affiliated to Capital University of Medicine were treated by laparoscopic cystectomy. Those patients were divided into two groups randomly, which were 28 patients in suture group and 33 patients in electro coagulation during the operation. Blood samples were obtained from the patients before the operation, on the day 2 or 3 of the second menstrual cycle after operation and the first menstrual cycle after 6 months operation. The serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E(2)) were tested. At the same time, total antral follicles (F(0)) and mean ovarian stromal peak systolic blood flow velocity (PSV) were detected by transvaginal ultrasonography to evaluate ovarian reserve function.
There was no significant difference in patients' clinical characteristics and ovarian reserve function between two groups (P > 0.05). In the suture group, the serum level of FSH were (10.2 +/- 2.0) U/L before operation, (11.0 +/- 2.2) U/L on day 2 or 3 of the second menstrual cycle and (11.5 +/- 2.5) U/L on day 2 or 3 of the first menstrual cycle after 6 months'operation respectively. In comparison of data before operation, it exhibited significant difference (P < 0.05); F(0) were 8.9 +/- 2.6 before operation, 7.8 +/- 2.1 on day 2 or 3 of the second menstrual cycle and 7.6 +/- 2.4 on day 2 or 3 of the first menstrual cycle after 6 months' operation. When compared with data before operation, it showed significant difference (P < 0.05); PSV were (0.104 +/- 0.017) m/s before operation, (0.084 +/- 0.016) m/s on day 2 or 3 of the second menstrual cycle, (0.086 +/- 0.022) m/s on day 2 or 3 of the first menstrual cycle after 6 months' operation, it also showed significant difference between preoperation and postoperation (P < 0.01). In the electro coagulation group, the serum level of E(2) were (166 +/- 19), (196 +/- 57), (205 +/- 65) pmol/L, serum level of FSH were (10.0 +/- 1.5), (12.2 +/- 2.6), (13.4 +/- 4.5) U/L, F(0) were 8.9 +/- 2.0, 6.5 +/- 2.0, 6.2 +/- 2.5 (P < 0.01); PSV were (0.101 +/- 0.016), (0.072 +/- 0.021), (0.067 +/- 0.024) m/s before operation and on day 2 or 3 of the second menstrual cycle after operation and the first menstrual cycle after 6 months operation. They all showed significant difference between preoperation and postoperation. In the second menstrual cycle post operation (on day 2 or 3), the data of F(0) and PSV were statistically different between the two groups (P < 0.05); in the first menstrual cycle 6 months after the operation (on day 2 or 3), The serum level of E(2), F(0) and PSV were statistically different between the two groups (P < 0.05).
It suggested that ovarian reserve function would be decreased in treatment of bilateral ovarian endometriotic cyst by laparoscopic cystectomy, it was more serious when electro coagulation hemostasis were given.
探讨不同止血方法的腹腔镜囊肿剔除术治疗卵巢子宫内膜异位囊肿对卵巢储备功能的影响。
选取2007年9月至2008年8月在北京大学第一医院及首都医科大学附属安贞医院行腹腔镜囊肿剔除术治疗的双侧卵巢子宫内膜异位囊肿患者61例，随机分为两组，缝合组28例，术中采用缝合止血；电凝组33例，术中采用电凝止血。于术前、术后第2或3个月经周期第2或3天、术后6个月第1个月经周期第2或3天采集患者血样，检测血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E₂）水平，同时经阴道超声检测窦卵泡总数（F₀）及卵巢基质收缩期峰值血流速度（PSV）均值，评估卵巢储备功能。
两组患者临床特征及卵巢储备功能比较，差异无统计学意义（P＞0.05）。缝合组术前血清FSH水平为（10.2±2.0）U/L，术后第2或3个月经周期第2或3天为（11.0±2.2）U/L，术后6个月第1个月经周期第2或3天为（11.5±2.5）U/L，与术前比较，差异有统计学意义（P＜0.05）；术前F₀为8.9±2.6个，术后第2或3个月经周期第2或3天为7.8±2.1个，术后6个月第1个月经周期第2或3天为7.6±2.4个，与术前比较，差异有统计学意义（P＜0.05）；术前PSV为（0.104±0.017）m/s，术后第2或3个月经周期第2或3天为（0.084±0.016）m/s，术后6个月第1个月经周期第2或3天为（0.086±0.022）m/s，术前与术后比较，差异有统计学意义（P＜0.01）。电凝组术前血清E₂水平为（166±19）pmol/L、术后第2或3个月经周期第2或3天为（196±57）pmol/L、术后6个月第1个月经周期第2或3天为（205±65）pmol/L，术前血清FSH水平为（10.0±1.5）U/L、术后第2或3个月经周期第2或3天为（12.2±2.6）U/L、术后6个月第1个月经周期第2或3天为（13.4±4.5）U/L，术前F₀为8.9±2.0个、术后第2或3个月经周期第2或3天为6.5±2.°个、术后6个月第1个月经周期第2或3天为6.2±2.5个，差异均有统计学意义（P＜0.01）；术前PSV为（0.101±0.016）m/s、术后第2或3个月经周期第2或3天为（0.072±0.021）m/s、术后6个月第1个月经周期第2或3天为（0.067±0.024）m/s，术前与术后比较，差异均有统计学意义。术后第2个月经周期第2或3天，两组F₀及PSV数据比较，差异有统计学意义（P＜0.05）；术后6个月第1个月经周期第2或3天，两组血清E₂、F₀及PSV比较，差异有统计学意义（P＜0.05）。
腹腔镜囊肿剔除术治疗双侧卵巢子宫内膜异位囊肿可导致卵巢储备功能下降，电凝止血对卵巢储备功能的影响更严重。
