不同方式的腹腔镜下卵巢型子宫内膜异位囊肿剥除术对卵巢功能的影响

发布时间：2018-03-31 17:53

本文选题：卵巢子宫内膜异位囊肿　切入点：卵巢储备功能　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:通过对比腹腔镜垂体后叶素水分离与电手术器械(单、双极电凝器)两种方式剥除卵巢型子宫内膜异位囊肿(Ovarian Endometriosis cyst,OEMC)在手术前后各指标间的差异,探讨两种手术方式对卵巢功能等的影响以及对卵巢型子宫内膜异位症手术方式的选择应用价值。方法:选取自2016年3月-2016年11月在河北医科大学第二医院妇科因OEMC就诊患者30例,随机分为水分离组(11例)和电器械组(19例),采集患者一般情况,比较两组的年龄、囊肿直径、术中出血情况;手术前后疼痛评分及术后妊娠情况;于术前、术后2天、术后1个月和术后3个月采集外周静脉血测定血清抗苗勒氏管激素(Anti-mullerian Hormone,AMH)以评估手术对卵巢功能的影响。术后妊娠者或应用促性腺激素释放激素激动剂(Gonadropin Releasing Hormone Agonist,Gn RHa)治疗者暂停采血。停用Gn RHa恢复月经后继续采血。结果:比较一般情况,两组患者年龄、囊肿大小、r-AFS评分、单双侧、术前血红蛋白(Hemoglobin,Hb)及AMH水平等差异无统计学意义(P0.05),具有可比性。不同手术方式对卵巢功能AMH的影响分析:随访满1个月的水分离组,术后2天、术后1个月较术前均下降,差异有统计学意义(n=11,P0.05),术后1个月较术后2天有统计学意义上升(n=11,P0.05),术后3个月较术后1个月有统计学意义上升(n=7,P0.05);随访满1个月的电器械组,术后2天、术后1个月较术前均下降,差异有统计学意义(n=19,P0.05),术后1个月较术后2天更低,差异有统计学意义(n=19,P0.05),术后3个月较术后1个月有统计学意义上升,且稍高于术后2天,差异有统计学意义(n=13,P0.05)。两组间比较:术前VS术后2天、术前VS术后1个月、术前VS术后3个月AMH水平差异,组间无统计学意义(n=30,P0.05;n=30,P0.05;n=20,P0.05)。分别比较两组手术前后疼痛视觉模拟评分(Visual Analogue Scale,VAS)及Hb变化,均较术前有统计学意义下降(P0.05),但两组间比较差异无统计学意义(n=30,P0.05)。此研究中共11人有生育需求,至随访周期结束,2人自然妊娠,1人试管妊娠。水分离组有2例患者(年龄36岁与37岁)卵巢功能术后一直下降至绝经水平。结论:1不论哪种手术方式,腹腔镜OEMC剥除术后卵巢功能均会有所损伤,虽然随着时间的推移术后卵巢功能会慢慢恢复,但是仍不会超过术前卵巢功能水平。2水分离组和电器械组术前、术后卵巢功能变化差异无统计学意义,说明两种手术方式对卵巢功能的损伤无明显差异。3所有受试者手术前后VAS及Hb差值具有统计学意义,推测EM手术难度较大,术中出血多且能有效改善痛经,但两组间变化无统计学差异,推测两种手术方式缓解疼痛及止血效果无明显差异。
[Abstract]:Objective: to compare the differences of the parameters of ovarian Endometriosis cystoma between laparoscopic posterior pituitary leaf water separation and electrosurgical instruments (single and bipolar electrocoagulators) before and after operation. To explore the effect of two kinds of surgical methods on ovarian function and the value of selection and application of surgical methods for ovarian endometriosis. Methods: from March 2016 to November 2016, the gynecologic patients were selected from the second Hospital of Hebei Medical University. 30 OEMC patients, The patients were randomly divided into water separation group (n = 11) and electric instrument group (n = 19). The age, diameter of cyst, intraoperative bleeding, pain score before and after operation and pregnancy were compared between the two groups. Peripheral venous blood samples were collected 1 month after operation and 3 months after operation to determine the serum anti-Mullerian hormone Anti-mullerian Hormoney (AMH) in order to evaluate the effect of the operation on ovarian function. After operation, pregnancy or gonadotropin Releasing Hormone Agonististen Gn RHaA were used. After stopping Gn RHa to resume menstruation, the patients continued to collect blood. Results: compared with the general situation, There were no significant differences in age, cysts size, r-AFS score, hemoglobin hemoglobin HB (HB) and AMH levels between the two groups (P 0.05). Analysis of the effects of different surgical methods on ovarian functional AMH: water separation group was followed up for one month. At 2 days after operation, 1 month after operation all decreased compared with those before operation, the difference was statistically significant (P 0. 05), 1 month after operation was significantly higher than 2 days after operation (P 0. 05), and 3 months after operation was significantly higher than that of 1 month after operation (P 0. 05). At 2 days after operation, 1 month after operation was lower than that before operation, the difference was statistically significant, and the difference was significantly lower at 1 month than that on 2 days after operation, the difference was statistically significant, and the difference was statistically significant at 3 months after operation compared with 1 month after operation, and slightly higher than that at 2 days after operation. The difference was statistically significant (P 0.05). The AMH levels were significantly different between the two groups 2 days after vs, 1 month after vs and 3 months after vs. There was no statistical significance between the two groups. Visual Analogue scale scale (vas) and HB before and after operation were compared between the two groups, but there was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups. There was no significant difference between the two groups. By the end of the follow-up period, 2 cases of spontaneous pregnancy and 1 case of tube pregnancy. In the water separation group, the ovarian function of 2 patients (aged 36 and 37 years) had been reduced to menopausal level after operation. Ovarian function was damaged after laparoscopic OEMC excision, although ovarian function recovered slowly over time, but it still did not exceed preoperative ovarian function level of 2.2-water separation group and electrical apparatus group. There was no significant difference in the changes of ovarian function after operation, which indicated that there was no significant difference between the two surgical methods in ovarian function injury. 3 the difference of VAS and HB in all subjects before and after operation was statistically significant, and it was speculated that EM operation was more difficult. Intraoperative bleeding can effectively improve dysmenorrhea, but there is no statistical difference between the two groups.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.6

【参考文献】