本文選題：卵巢子宮內(nèi)膜異位囊腫　切入點：卵巢儲備功能　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過對比腹腔鏡垂體后葉素水分離與電手術(shù)器械(單、雙極電凝器)兩種方式剝除卵巢型子宮內(nèi)膜異位囊腫(Ovarian Endometriosis cyst,OEMC)在手術(shù)前后各指標(biāo)間的差異,探討兩種手術(shù)方式對卵巢功能等的影響以及對卵巢型子宮內(nèi)膜異位癥手術(shù)方式的選擇應(yīng)用價值。方法:選取自2016年3月-2016年11月在河北醫(yī)科大學(xué)第二醫(yī)院婦科因OEMC就診患者30例,隨機分為水分離組(11例)和電器械組(19例),采集患者一般情況,比較兩組的年齡、囊腫直徑、術(shù)中出血情況;手術(shù)前后疼痛評分及術(shù)后妊娠情況;于術(shù)前、術(shù)后2天、術(shù)后1個月和術(shù)后3個月采集外周靜脈血測定血清抗苗勒氏管激素(Anti-mullerian Hormone,AMH)以評估手術(shù)對卵巢功能的影響。術(shù)后妊娠者或應(yīng)用促性腺激素釋放激素激動劑(Gonadropin Releasing Hormone Agonist,Gn RHa)治療者暫停采血。停用Gn RHa恢復(fù)月經(jīng)后繼續(xù)采血。結(jié)果:比較一般情況,兩組患者年齡、囊腫大小、r-AFS評分、單雙側(cè)、術(shù)前血紅蛋白(Hemoglobin,Hb)及AMH水平等差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。不同手術(shù)方式對卵巢功能AMH的影響分析:隨訪滿1個月的水分離組,術(shù)后2天、術(shù)后1個月較術(shù)前均下降,差異有統(tǒng)計學(xué)意義(n=11,P0.05),術(shù)后1個月較術(shù)后2天有統(tǒng)計學(xué)意義上升(n=11,P0.05),術(shù)后3個月較術(shù)后1個月有統(tǒng)計學(xué)意義上升(n=7,P0.05);隨訪滿1個月的電器械組,術(shù)后2天、術(shù)后1個月較術(shù)前均下降,差異有統(tǒng)計學(xué)意義(n=19,P0.05),術(shù)后1個月較術(shù)后2天更低,差異有統(tǒng)計學(xué)意義(n=19,P0.05),術(shù)后3個月較術(shù)后1個月有統(tǒng)計學(xué)意義上升,且稍高于術(shù)后2天,差異有統(tǒng)計學(xué)意義(n=13,P0.05)。兩組間比較:術(shù)前VS術(shù)后2天、術(shù)前VS術(shù)后1個月、術(shù)前VS術(shù)后3個月AMH水平差異,組間無統(tǒng)計學(xué)意義(n=30,P0.05;n=30,P0.05;n=20,P0.05)。分別比較兩組手術(shù)前后疼痛視覺模擬評分(Visual Analogue Scale,VAS)及Hb變化,均較術(shù)前有統(tǒng)計學(xué)意義下降(P0.05),但兩組間比較差異無統(tǒng)計學(xué)意義(n=30,P0.05)。此研究中共11人有生育需求,至隨訪周期結(jié)束,2人自然妊娠,1人試管妊娠。水分離組有2例患者(年齡36歲與37歲)卵巢功能術(shù)后一直下降至絕經(jīng)水平。結(jié)論:1不論哪種手術(shù)方式,腹腔鏡OEMC剝除術(shù)后卵巢功能均會有所損傷,雖然隨著時間的推移術(shù)后卵巢功能會慢慢恢復(fù),但是仍不會超過術(shù)前卵巢功能水平。2水分離組和電器械組術(shù)前、術(shù)后卵巢功能變化差異無統(tǒng)計學(xué)意義,說明兩種手術(shù)方式對卵巢功能的損傷無明顯差異。3所有受試者手術(shù)前后VAS及Hb差值具有統(tǒng)計學(xué)意義,推測EM手術(shù)難度較大,術(shù)中出血多且能有效改善痛經(jīng),但兩組間變化無統(tǒng)計學(xué)差異,推測兩種手術(shù)方式緩解疼痛及止血效果無明顯差異。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R713.6

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