Zhang Chun-Hua, Wu Ling, Li Pei-Quan
Huai'an Maternal and Child Health Care Center, Huai'an City, PR China.
Huai'an Maternal and Child Health Care Center, Huai'an City, PR China.
Taiwan J Obstet Gynecol. 2016 Aug;55(4):507-11. doi: 10.1016/j.tjog.2015.08.026.
To evaluate the impact of different hemostasis methods on ovarian reserve in laparoscopic cystectomy in treatment of ovarian endometrioma for the long-term.
A total of 207 patients with ovarian endometrioma, aged from 18 years to 45 years, were randomized into three groups: Group A (69 patients) treated by bipolar electrocoagulation hemostasis in laparoscopic cystectomy for ovarian endometrioma; Group B (69 patients) with ultrasound scalpel hemostasis; and Group C (69 patients) with suture technique hemostasis. The follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC), and peak systolic velocity (PSV) were observed and compared at the 3(rd) day of the 1(st), 3(rd), 6(th), and 12(th) menstrual cycle after surgery.
(1) A total of 13 out of 207 patients failed; four in Group A, five in Group B, and four in Group C. There was no statistically significant difference between groups (p > 0.05). The failure rate was the highest during the 3(rd) month in the follow up (10 cases). (2) FSH: at the 1(st) month, 3(rd) month, 6(th) month, and 12(th) month follow up, FSH was higher in Group A and Group B than in Group C (p < 0.05). (3) AMH: AMH was significantly lower in Group A and Group B than in Group C (p < 0.05) during the same period. (4) AFC: no difference of AFC was observed at the 1(st) month and 3(rd) month (p > 0.05), whereas at the 6(th) month and 12(th) month, AFC in Group C was obviously higher than that in Group A and Group B (p < 0.05). (5) PSV: at the 1(st) month, 3(rd) month, 6(th) month, and 12(th) month follow up, PSV was significantly lower in Group A and in Group B than in Group C (p < 0.05).
Ultrasonic scalpel or bipolar electrocoagulation hemostasis applied to laparoscopic cystectomy is associated with a significant reduction of ovarian reserve. Electrocoagulation of hemostasis should be used with caution.
长期评估不同止血方法对腹腔镜下卵巢子宫内膜异位囊肿剔除术中卵巢储备功能的影响。
选取207例年龄在18至45岁之间的卵巢子宫内膜异位症患者，随机分为三组：A组（69例），采用双极电凝止血法进行腹腔镜下卵巢子宫内膜异位囊肿剔除术；B组（69例），采用超声刀止血；C组（69例），采用缝合技术止血。在术后第1、3、6和12个月经周期的第3天观察并比较促卵泡生成素（FSH）、抗苗勒管激素（AMH）、窦卵泡计数（AFC）和收缩期峰值流速（PSV）。
（1）207例患者中共有13例失败；A组4例，B组5例，C组4例。组间差异无统计学意义（p>0.05）。随访期间第3个月失败率最高（10例）。（2）FSH：在术后第1、3、6和12个月随访时，A组和B组的FSH高于C组（p<0.05）。（3）AMH：同期A组和B组的AMH显著低于C组（p<0.05）。（4）AFC：在术后第1个月和第3个月，AFC无差异（p>0.05），而在第6个月和第12个月，C组的AFC明显高于A组和B组（p<0.05）。（5）PSV：在术后第1、3、6和12个月随访时，A组和B组的PSV显著低于C组（p<0.05）。
腹腔镜囊肿剔除术中应用超声刀或双极电凝止血与卵巢储备功能显著降低有关。电凝止血应谨慎使用。
