本文選題：成熟畸胎瘤 + 腹腔鏡�。� 參考：《安徽醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的隨著社會(huì)的發(fā)展和醫(yī)學(xué)技術(shù)的不斷進(jìn)步,腹腔鏡技術(shù)在婦科的應(yīng)用越來(lái)越廣泛,人們對(duì)于疾病治療的技術(shù)水平以及治療后個(gè)人精神狀態(tài)和生活質(zhì)量要求也增高了很多。而腹腔鏡已經(jīng)成為治療卵巢成熟性畸胎瘤的首選手術(shù)方法,但對(duì)于卵巢成熟畸胎瘤與卵巢儲(chǔ)備功能的情況以及腹腔鏡下成熟畸胎瘤剔除術(shù)中不同的止血方法對(duì)卵巢儲(chǔ)備功能的影響,目前尚沒有公認(rèn)的精確的評(píng)價(jià)指標(biāo),也尚未得出明確的結(jié)論。本文通過將卵巢成熟畸胎瘤患者和健康成年女性的卵巢儲(chǔ)備功能進(jìn)行比較,把接受手術(shù)的成熟畸胎瘤患者分為電凝止血和縫合止血兩組,研究它們卵巢儲(chǔ)備功能的變化情況,尋求出更敏感的卵巢儲(chǔ)備功能的評(píng)價(jià)指標(biāo),探討卵巢成熟畸胎瘤是否對(duì)卵巢儲(chǔ)備功能有影響,并找出更好保護(hù)卵巢儲(chǔ)備功能的止血方式。方法選取2014年2月至2015年7月在北京軍區(qū)總醫(yī)院婦產(chǎn)科體檢的正常育齡婦女(對(duì)照組)40例和因卵巢畸胎瘤行腹腔鏡下卵巢畸胎瘤剔除術(shù)的40例患者(治療組)。將治療組40例患者根據(jù)止血方式的不同隨機(jī)分成兩組:使用縫合止血方法的為縫合組(20例)和使用雙極電凝止血方法的為電凝組(20例)。治療組術(shù)后3天、術(shù)前末次月經(jīng)及術(shù)后第1、3、6個(gè)月月經(jīng)第2-4天,對(duì)照組術(shù)前末次月經(jīng)的月經(jīng)第2-4天上午8-9時(shí)抽肘靜脈血3-5ml檢測(cè)雌二醇(estradiol,E2)、黃體生成素(luteinizing hormone,LH)、卵泡刺激素(follicle-stimulating hormone,FSH)、抗苗勒管激素(anti-mullerian hormone,AMH)。比較術(shù)前治療組與對(duì)照組的卵巢儲(chǔ)備功能情況,以及術(shù)中采用不同止血方法后各檢測(cè)指標(biāo)的變化情況,以評(píng)價(jià)不同止血方法對(duì)卵巢儲(chǔ)備功能的影響。結(jié)果(1)治療組與健康對(duì)照組一般情況相比較,兩組年齡、體重指數(shù)、黃體生成素、卵泡刺激素、雌二醇的體內(nèi)水平相比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。但治療組比健康對(duì)照組的體內(nèi)血清抗苗勒管激素水平值低,差異有統(tǒng)計(jì)學(xué)意義 (P0.05)。電凝組和縫合組檢測(cè)在術(shù)后各時(shí)間段兩組組間的血清指標(biāo)LH,FSH,E2變化情況未見明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但兩組AMH指標(biāo)在術(shù)后各時(shí)間段兩組組間的變化,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)電凝組術(shù)后3天LH值上升,超出正常范圍,隨后逐漸下降到術(shù)后6個(gè)月至正常水平,兩組術(shù)后各時(shí)間點(diǎn)與術(shù)前FSH值相比較,FSH水平較高,兩組術(shù)后3天FSH指標(biāo)均顯著上升,術(shù)后3月開始顯著下降至正常水平,但比術(shù)前仍高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組術(shù)后3天AMH均下降,隨后逐漸恢復(fù),電凝組直至術(shù)后6月AMH恢復(fù)術(shù)前水平,縫合組術(shù)后1月即可恢復(fù)至術(shù)前水平,術(shù)后6月卵巢功能更優(yōu)于術(shù)前,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后各時(shí)間點(diǎn)兩組卵巢功能下降人數(shù)比率未見明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論(1)卵巢儲(chǔ)備功能的檢測(cè)指標(biāo)中AMH比FSH,LH,E2更好的評(píng)價(jià)卵巢儲(chǔ)備功能。(2)成熟畸胎瘤患者比健康女性的血清AMH值低,成熟畸胎瘤可能影響患者的卵巢儲(chǔ)備功能,臨床應(yīng)注意成熟畸胎瘤患者的卵巢儲(chǔ)備功能的情況。(3)腹腔鏡成熟畸胎瘤剔除術(shù)中縫合法止血比電凝法止血更有利于卵巢功能的保護(hù)。這些研究發(fā)現(xiàn)可指導(dǎo)臨床成熟畸胎瘤的診療操作,成熟畸胎瘤剝除術(shù)中采用縫合止血方法值得臨床進(jìn)一步的推廣。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R737.31

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