| The incidence of endometriosis has recently increased significantly.Endometriosis is generally found in women of childbearing age and laparoscopy is the main means for the surgical treatment of endometriosis.For this age group of patients,the main surgical approach taken is laparoscopic endometrioma stripping.Doctors must strive to remove the lesions completely,and also need to pay attention to protect the patient's reproductive and endocrine function during surgery.The border between ovarian endometrioma cyst wall and normal ovarian tissue is unclear,difficult to strip and easy to bleed.Intraoperative repeated coagulation increased damage to ovarian tissue,especially for recurrent and bilateral endometrioma patients.Surgery may lead to ovarian reserve function decreased,and even the occurrence of premature ovarian failure.Therefore,how to reduce ovarian injury in laparoscopic surgery has become the focus of the study.We innovatively used vasopressin injection technique in endometrioma strtipping,which was inspired from applying vasopressin in the operation of myomectomy.We improved the injection technique in site and drug concentration.6 units of vasopressin was diluted into 50 ml with normal saline and the final concentration was 0.12U/ml.The diluted vasopressin was injected in the gap between ovarian cortex and cyst wall forming a water cushion.In this paper,we compared laparoscopic ovarian endometrioma stripping with vasopressin injection technique and common surgical method without using the injection technique.The anti-Mullerian hormone(AMH),follicle stimulating hormone(FSH),estradiol(E2),ovarian antral follicle count(AFC)and ovarian volume were measured to evaluate the effects of vasopressin injection technique on ovarian reserve function.To investigate the possible mechanisms and influence factors of the effect of vasopressin injection technique on ovarian reserve function,we analyzed the amount of bleeding,coagulation times,operation time and the thickness of residual ovarian tissue after operation and observed patient's postoperative recovering conditions and the volume and color of abdominal pelvic drainage fluid at the same time.vasopressin injection technique is safe,simple,effective,minimally invasive,and which can reduce the damage to the ovarian reserve.Part ? The effect of vasopressin injection technique on ovarian reserve evaluated by peripheral blood hormoneObjective: Endometriosis(EM)mainly occurs in women of childbearing age,and about 80% of infertility patients have endometriosis.Endometrioma is a common type of endometriosis which can lead to chronic pelvic pain,infertility and seriously affect the quality of life of women of childbearing age.Recent studies have found that laparoscopic bilateral ovarian endometrioma stripping could cause to advance the age of menopause and increase the risk of premature ovarian failure.Therefore,the question of how to reduce ovarian damage during laparoscopic surgery has become a focus of gynecology and reproductive science.At present,domestic and international counterparts are seeking a safe,effective and easy to learn method to reduce ovarian damage.In this study,we was inspired from laparoscopic myomectomy using vasopressin injection,and first time used vasopressin injection technique in laparoscopic endometrioma stripping.Anti-Mullerian(AMH),follicle stimulating hormone(FSH)and estradiol(E2)of peripheral blood were detected to evaluate the effect of the new technique on ovarian reserve.Methods: 84 cases of patients with bilateral ovarian chocolate cysts were randomly divided into study group and control group by random number table method.The study group(n = 42)with vasopressin injection technique had a mean age of 28.4±11.8 years old(range,19-43 years old),and the control group(n = 42)with no vasopressin injection technique was 30.4±10.6 years old(range,20-42 years old).Diluted vasopressin(6 U pituitrin diluted into 50 ml)was injected into the tissue space between the ovarian cortex and the cyst wall to form a water cushion using a 22 G laparoscopic needle in the study group.The control group did not use this injection technique.Operations were completed by the same group physicians.Anti-Müllerian hormone,follicle stimulating hormone and estradiol were measured on 2-3 days of menstrual cycle before operation and 3 months after operation.Results: Two groups of patients were successfully completed the operation.The study group patients' blood pressure was stable.Anaphylactic shock and other adverse reactions didn't happen in the operation.The serum levels of anti-Müllerian hormone before and after operation and change in the study group were 3.64±1.25ng/ml,2.97±1.27ng/ml and 0.48±0.11,respectively.The control group was 3.67±1.45ng/ml,2.35±1.08ng/ml and 1.42±0.21,respectively.There was significant difference in the descending rate between the two groups(P <0.01).The serum levels of FSH before and after operation and change in the study group were 7.12±1.52 m IU/ml,7.86±2.45mIU/ml and 0.12±0.04,respectively,The control group was 7.34±2.41 m IU/ml,7.97±2.24mIU/ml and 0.09±0.05,respectively.The serum estradiol levels before and after operation and change in the study group were 166.42±11.48pg/ml,160.47±12.78pg/ml,and 5.28±1.45,respectively.The control group was 172.28±9.48 pg/ml,166.78±10.65pg/ml,and 5.47±2.41,respectively.There were no significant differences in pre-operative AMH,FSH and E2 between the two groups(P> 0.05).There were no significant differences in change of FSH and E2 between the two groups(P> 0.05).The differences of AMH between before and after operation in the two groups were statistically significant(P <0.01).At the same time,there was a negative correlation between age and preoperative AMH level(r =-0.810,P <0.05).Conclusion: Laparoscopic bilateral ovarian endometrioma stripping can injury the ovaries and lead to ovarian reserve function decreased after surgery.Age is an important predictor of preoperative AMH levels in patients with endometriomas.vasopressin injection technique in laparoscopic bilateral ovarian endometrioma stripping is safe and there is no obvious complication in patients.At the same time,the technology can effectively reduce ovarian damage and protect the ovarian reserve,reproductive function and endocrine function.What's more,the technology is minimally invasive,safe,simple,effective and easy to be popularized and applied.Part ? The effect of vasopressin injection technique on ovarian reserve evaluated by ultrasonographyObjective: Endometriosis(EM)is a common disease in women of childbearing age.Ovarian is the most prone to endometriosis.About 50% of patients have bilateral ovary involved.Currently laparoscopic diagnosis,surgery plus drugs are gold standard for the treatment of endometriosis.However,more and more attention has been paid to the damage of ovarian function.Therefore,how to protect the ovarian reserve in the process of laparoscopic surgery is particularly important,especially for patients with bilateral ovarian endometriomas.In this study,we used vasopressin injection technique in bilateral ovarian endometriosis cystectomy and detected the changes of antral follicle count(AFC),ovarian volume(OV),and peak systolic velocity(PSV)of ovarian stromal artery by transvaginal ultrasonography to evaluate the effect of this technique on ovarian reserve function.Methods: 84 cases of patients with bilateral ovarian endometriomas were collected in our hospital.The patients were allocated into study group and control group by random number table method.In the study group,the vasopressin injection technique was used,but the control group did not use this technique.The differences in preoperative age,body mass index,onset time and course of disease,ovarian endometriosis cyst diameter and postoperative endometriosis staging [American Fertility Society 1985 revised endometriosis staging(r-AFS)] between two groups were not statistically significant(P> 0.05).The antral follicle count,ovarian volume and peak systolic velocity(PSV)of ovarian stromal artery were detected by color Doppler ultrasonography at 1 month before operation and 6 months after operation.All examinations were performed by the same ultrasound physician.Results: 84 patients underwent laparoscopic surgery successfully without severe perioperative complications.postoperative pathological examination confirmed ovarian endometriosis cyst in two groups.There was significant difference in blood loss and operation time between the two groups(P <0.01).The AFC before and after operation in the study group were 5.96±1.28 and 4.12±2.21,respectively.The control group were 5.07±2.03 and 2.76±1.42,respectively.The ovarian volume before and after operation in the study group were 13.74±3.45 ml and 9.16±2.87 ml,respectively.The control group were 12.62±2.01 ml and 5.75±2.32 ml,respectively.The PSV before and after operation in the study group were 14.72±3.92 cm/s and 12.13±3.86 cm/s,respectively.The control group were 15.07±4.97cm/s and 7.07±4.19 cm/s,respectively.There was no significant difference in the AFC,ovarian volume and PSV between the two groups before operation(P> 0.05).There were statistically significantly greater decrease in postoperative AFC,ovarian volume and PSV as compared with the preoperative values in both groups(P <0.01).AFC reduction rate of study group(16.54 ± 1.24))%was less than control group(42.21±18.57)%,and the difference was statistically significant(P <0.01).Ovarian volume reduction rate of study group(30.25±7.61)% was less than control group(56.76±3.29)%,and the difference was statistically significant(P <0.01).PSV reduction rate of study group(3.57±3.97)% was less than control group(8.86±2.27)%,and the difference was statistically significant(P <0.01).Conclusion: Ovarian reserve function was decreased during the operation of laparoscopical bilateral ovarian endometriomas stripping.The vasopressin injection technique used in operation can reduce the damage to the ovarian reserve.The technique has important clinical significance,which can protect the reproductive capacity of young patients with bilateral ovarian endometriomas,as well as the eugenics of relevant population.At the same time,ultrasonography is a simple,safe,noninvasive,repeatable technique in the evaluation of ovarian reserve function and also has a unique advantage.Part ? Clinical analysis of the influence factors of vasopressin injection technique on ovarian reserveObjective: To further study the influence factors of vasopressin injection technique on ovarian reserve by prospective case-control clinical analysis.Methods: Sixty patients with unilateral ovarian endometrioma were selected for primary operation.All selected patients had no medication history.Ovarian malignancies were excluded.60 patients were randomly divided into two groups using random number table method.In the study group,the vasopressin injection technique was used,but the control group did not use this technique.The differences in preoperative age,body mass index,time of onset and course of disease,cyst diameter of ovarian endometrioma and postoperative endometriosis staging(R-AFS)between two groups were not statistically significant(P> 0.05).The operation time(from the beginning of endometrioma stripping to the end of hemostasis),amount of bleeding,number of bipolar coagulation,operative complications were collected,and the thickness of residual ovarian tissue in the cyst wall was examined at the histopathological level.Results: Sixty patients underwent laparoscopic surgery successfully without severe perioperative complications.In the study group,the patients had stable blood pressure,and no severe anaphylactic shock.All the specimens were confirmed as ovarian endometriotic cysts by pathological examination.The amount of bleeding,time of operation,number of bipolar coagulation and residual ovarian tissue thickness of the postoperative capsule wall were 38.2 ± 23.4ml,8.4 ± 2.3min,48.2 ± 28.3 times and 0.44 ± 0.20 mm in the study group,respectively;the control group were 65.6 ± 26.6ml,12.4 ± 2.8min,120.3 ± 30.4 times and 0.89 ± 0.41 mm,respectively.There were significant differences in blood loss,operative time,coagulation frequency and thickness of residual ovarian tissue in the cyst wall between the study group and the control group(P <0.01).In the study group,the highest body temperature,anal exhaust time,and abdominal drainage fluid volume were 37.6 ± 0.9 ?,19.8 ± 9.4h and 70.8 ± 30.8ml,respectively.21 cases of light yellow liquid and 9 cases of light red blood were drained.The control group were 37.4 ± 0.8 ?,21.9 ± 10.2h and 75.9 ± 40.5ml,respectively.22 cases of light yellow liquid and 8 cases of light red blood were drained.There were no significant differences between the two groups in terms of the highest body temperature,anal exhaust time,and abdominal drainage fluid volume(P> 0.05).Conclusion: The improved vassopressin injection technique can reduce the damage to the ovarian reserve by hydraulic separation,vasoconstriction,clear surgical field,reducing bleeding,shortening the operation time,reducing the number of coagulation and reducing the loss of normal ovarian tissue. |
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