腹腔镜卵巢成熟畸胎瘤剥除术中不同止血方法对卵巢储备功能的影响

发布时间：2018-05-08 23:10

本文选题：成熟畸胎瘤 + 腹腔镜　；参考：《安徽医科大学》2016年硕士论文

【摘要】：目的随着社会的发展和医学技术的不断进步,腹腔镜技术在妇科的应用越来越广泛,人们对于疾病治疗的技术水平以及治疗后个人精神状态和生活质量要求也增高了很多。而腹腔镜已经成为治疗卵巢成熟性畸胎瘤的首选手术方法,但对于卵巢成熟畸胎瘤与卵巢储备功能的情况以及腹腔镜下成熟畸胎瘤剔除术中不同的止血方法对卵巢储备功能的影响,目前尚没有公认的精确的评价指标,也尚未得出明确的结论。本文通过将卵巢成熟畸胎瘤患者和健康成年女性的卵巢储备功能进行比较,把接受手术的成熟畸胎瘤患者分为电凝止血和缝合止血两组,研究它们卵巢储备功能的变化情况,寻求出更敏感的卵巢储备功能的评价指标,探讨卵巢成熟畸胎瘤是否对卵巢储备功能有影响,并找出更好保护卵巢储备功能的止血方式。方法选取2014年2月至2015年7月在北京军区总医院妇产科体检的正常育龄妇女(对照组)40例和因卵巢畸胎瘤行腹腔镜下卵巢畸胎瘤剔除术的40例患者(治疗组)。将治疗组40例患者根据止血方式的不同随机分成两组:使用缝合止血方法的为缝合组(20例)和使用双极电凝止血方法的为电凝组(20例)。治疗组术后3天、术前末次月经及术后第1、3、6个月月经第2-4天,对照组术前末次月经的月经第2-4天上午8-9时抽肘静脉血3-5ml检测雌二醇(estradiol,E2)、黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle-stimulating hormone,FSH)、抗苗勒管激素(anti-mullerian hormone,AMH)。比较术前治疗组与对照组的卵巢储备功能情况,以及术中采用不同止血方法后各检测指标的变化情况,以评价不同止血方法对卵巢储备功能的影响。结果(1)治疗组与健康对照组一般情况相比较,两组年龄、体重指数、黄体生成素、卵泡刺激素、雌二醇的体内水平相比较,差异无统计学意义(P0.05)。但治疗组比健康对照组的体内血清抗苗勒管激素水平值低,差异有统计学意义 (P0.05)。电凝组和缝合组检测在术后各时间段两组组间的血清指标LH,FSH,E2变化情况未见明显差异,差异无统计学意义(P0.05),但两组AMH指标在术后各时间段两组组间的变化,差异有统计学意义(P0.05)。(2)电凝组术后3天LH值上升,超出正常范围,随后逐渐下降到术后6个月至正常水平,两组术后各时间点与术前FSH值相比较,FSH水平较高,两组术后3天FSH指标均显著上升,术后3月开始显著下降至正常水平,但比术前仍高,差异均有统计学意义(P0.05)。两组术后3天AMH均下降,随后逐渐恢复,电凝组直至术后6月AMH恢复术前水平,缝合组术后1月即可恢复至术前水平,术后6月卵巢功能更优于术前,差异均有统计学意义(P0.05)。术后各时间点两组卵巢功能下降人数比率未见明显差异,差异无统计学意义(P0.05)。结论(1)卵巢储备功能的检测指标中AMH比FSH,LH,E2更好的评价卵巢储备功能。(2)成熟畸胎瘤患者比健康女性的血清AMH值低,成熟畸胎瘤可能影响患者的卵巢储备功能,临床应注意成熟畸胎瘤患者的卵巢储备功能的情况。(3)腹腔镜成熟畸胎瘤剔除术中缝合法止血比电凝法止血更有利于卵巢功能的保护。这些研究发现可指导临床成熟畸胎瘤的诊疗操作,成熟畸胎瘤剥除术中采用缝合止血方法值得临床进一步的推广。
[Abstract]:Objective with the development of society and the continuous progress of medical technology, the application of laparoscopy in gynecology is becoming more and more extensive. The technical level of disease treatment and the requirements of individual mental state and quality of life after treatment are also increased. But laparoscopy has become the first choice for the treatment of mature teratoma of the ovary. There is no recognized accurate evaluation of ovarian mature teratoma and ovarian reserve function and the effect of different methods of hemostasis on ovarian reserve function during laparoscopic mature teratoma culling. The ovarian reserve function was compared, and the patients who received the mature teratoma were divided into two groups: electrocoagulation hemostasis and suture hemostasis. The changes of their ovarian reserve function were studied, and the more sensitive index of ovarian reserve function was sought. The effect of ovarian mature teratoma on ovarian reserve function was explored and better protection eggs were found. Methods 40 cases of normal childbearing age women (control group) and 40 cases of ovarian teratoma excluding ovarian teratoma were selected from February 2014 to July 2015 in the Department of gynaecology and obstetrics, General Hospital of Beijing Military Region, and 40 patients in the treatment group were randomly divided into two groups according to the difference of hemostasis. The suture group (20 cases) and the use of bipolar electrocoagulation (20 cases) were used as suture group (20 cases) and bipolar electrocoagulation hemostasis (20 cases). The treatment group was 3 days after operation, last menstruation before operation and 2-4 days after the 1,3,6 month of the operation. The control group took 3-5ml of the elbow vein blood to detect estradiol (estradiol, E2), and the luteal formation of the corpus luteum on the 2-4 day of the last menstrual period of the control group. Luteinizing hormone (LH), follicle stimulating hormone (follicle-stimulating hormone, FSH), anti lerleroid hormone (anti-Mullerian hormone, AMH). Compare the ovarian reserve function of the pre operation and control groups, as well as the changes of the indexes after the use of different hemostasis methods in order to evaluate the ovarian reserve of different hemostasis methods. Results (1) compared with the health control group, there was no significant difference between the two groups of age, body mass index, luteinizing hormone, follicular stimulating hormone and estradiol in the body level (P0.05), but the treatment group was lower than the healthy control group, and the difference was statistically significant. (P0.05). There was no significant difference in the changes of serum index LH, FSH and E2 between the two groups after the operation of the electrocoagulation group and the suture group. The difference was not statistically significant (P0.05), but the difference between the two groups of AMH indexes between the two groups after the operation was statistically significant (P0.05). (2) the LH value of the electrocoagulation group increased 3 days after the operation, exceeding the normal norm. Circumference, then gradually descended to 6 months to 6 months to the normal level, the two groups were compared with the preoperative FSH value, the level of FSH was higher, and the two groups were significantly increased on the 3 day after the operation, and the difference was statistically significant (P0.05) in March. The difference was statistically significant (P0.05). The two group decreased at the 3 day after the operation, and gradually gradually decreased, followed by gradually gradually. Recovery, electrocoagulation group until the level of AMH recovery in June after operation, the suture group could recover to the preoperative level in January after operation, and the ovarian function was better than before operation in June. The difference was statistically significant (P0.05). There was no significant difference between the two groups of ovarian function decline at every time point after operation (P0.05). Conclusion (1) ovarian reservoir AMH is better than FSH, LH and E2 to evaluate ovarian reserve function. (2) mature teratoma patients have lower serum AMH than healthy women. Mature teratoma may affect ovarian reserve function in patients. (3) laparoscopic mature teratoma culling in patients with mature teratoma. Legal hemostasis is more beneficial to the protection of ovarian function than electrocoagulation. These studies have been found to guide the diagnosis and treatment of clinical mature teratoma. The method of suturing hemostasis in mature teratoma excision is worthy of further clinical application.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.31

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