Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, China.
Arch Gynecol Obstet. 2023 Sep;308(3):927-934. doi: 10.1007/s00404-023-07088-4. Epub 2023 Jun 18.
To compare the ovarian reserve of different hemostatic methods after laparoscopic endometrioma stripping (LES) and explore which factors may affect ovarian reserve.
Patients who underwent LES from January 2019 to December 2021 were retrospectively included. Anti-Müllerian hormone (AMH) levels were measured before, and 3 months after surgery to determine changes of serum AMH in each patient. A multivariate linear regression analysis was performed to identify significant factors that were associated with the rate of decline of serum AMH levels at month 3 after surgery.
A total of 67 patients who underwent LES were included. Of these patients, 20 with gauze packing, 24 with bipolar dessication (BD), and 23 with suture to achieve hemostasis. The 3 groups were similar in terms of demographics, cyst diameter, and basal AMH levels, except basal hemoglobin levels. At 3 months after surgery, the decline rate of AMH levels was significantly greater in the suture and BD group compared with the gauze packing group [48.2% (interquartile range, IQR, 28.1-67.1) and 31.1% (IQR,14.6-49.1) vs. 15.1% (IQR,1.1-24.5), P = 0.001]. On multivariate regression models, significant predictors of the decline rate of serum AMH levels at 3 months after surgery were hemostatic methods (p < 0.001), basal AMH levels (p = 0.033), and lesion bilaterality (p = 0.017).
Compared to BD or suturing hemostasis, gauze packing hemostasis led to less damage on ovarian reserve at 3 months after LES. Besides, hemostatic methods, bilateral endometriomas and basal ovarian reserve were independently correlated with the impairment of ovarian reserve after surgery.
比较腹腔镜子宫内膜异位症囊肿剥除术(LES)后不同止血方法对卵巢储备功能的影响,并探讨哪些因素可能影响卵巢储备功能。
回顾性纳入 2019 年 1 月至 2021 年 12 月期间接受 LES 的患者。在术前和术后 3 个月测量抗苗勒管激素(AMH)水平,以确定每位患者术后血清 AMH 的变化。采用多元线性回归分析确定与术后 3 个月血清 AMH 水平下降率相关的显著因素。
共纳入 67 例接受 LES 的患者。其中 20 例采用纱布填塞止血,24 例采用双极电凝干燥止血,23 例采用缝合止血。三组患者在人口统计学特征、囊肿直径和基础 AMH 水平方面相似,但基础血红蛋白水平除外。术后 3 个月时,缝合和双极电凝组的 AMH 水平下降率明显高于纱布填塞组[48.2%(四分位距 IQR,28.1-67.1)和 31.1%(IQR,14.6-49.1)比 15.1%(IQR,1.1-24.5),P=0.001]。在多元回归模型中,术后 3 个月血清 AMH 水平下降率的显著预测因素是止血方法(p<0.001)、基础 AMH 水平(p=0.033)和病变双侧性(p=0.017)。
与双极电凝或缝合止血相比,纱布填塞止血在 LES 术后 3 个月时对卵巢储备功能的损害较小。此外,止血方法、双侧子宫内膜异位症和基础卵巢储备与术后卵巢储备功能损害独立相关。