The Effect Of Laparoscopic Ovarian Cystectomy At Different Phases Of The Menstrual Cycle

Purpose:To analyze the effect on ovarian function after laparoscopic ovarian cystectomy at different phases of the menstrual cycle.Materials and Methods:The clinical data of22cases of benign ovarian cyst undergone laparoscopic cystectomy and postoperative cesarean section of full-term pregnancy treated from January2009to January2012in Shandong Provincial Qianfoshan Hospital were analyzed retrospectively. Based on the phases of menstrual cycle at the time of oophorocystectomy, they were divided into follicular phase group(n=12) and luteal phase group(n=10).The size of bilateral ovaries were observed during cesarean section.Sixty patients of benign ovarian cyst undergoing laparoscopic cystectomy treated from September2011to March2012in Shandong Provincial Qianfoshan Hospital were studied in a prospective clinical trial. Based on the phases of menstrual cyle at the time of operation, they were divided into follicular phase group(n=30) and luteal phase group(n=30).The size of bilateral ovaries before operation, blood flow(blood flow resistance index around follicles, ovarian stromal artery peak systolic blood flow), operation time and intraoperative blood loss, the levels of estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH) before and two days after surgery were compared between two groups.Results:The ovarian volume at the time of cesarean section after laparoscopic excision of ovarian cysts:to follicular phase group; the volume of contralateral ovary was8.53±5.12cm3, and the mean volume of operated ovary was7.91±0.07cm3.There was no statistically significant of the difference between the volume of the ipsilateral ovary and the contralateral ovary (p>0.05). In luteal phase group, the volume of contralateral ovary was8.98±5.98cmJ,which the volume of the operated ovary was6.48±0.09cm3.The volume of the operated ovary was decreased significantly (p< 0.05)compared with the contralateral ovary. Parameters found in the prospective studyIn the propective study, we found that there was no statistically difference of the ovarian cyst between the two groups(P>0.05).The volume of the contralateral ovaries in luteal phase was larger than that in the follicular phase(10.98±5.98cm3vs8.33±5.12cm3)(P<0.05).The blood flow resistance index around follicles (RI, bilateral ovaries on average) in the follicular phase group was lower, the arterial blood flow peak systolic velocity (PSV, bilateral ovaries on average) of ovarian stroma was higher, the difference was statistically significant (P<0.05). In luteal phase group:there was a ring of distribution of blood flow around the luteus.In the luteal phase group, postoperative serum E2values decreased significantly (P<0.05), FSH and LH increased markedly (P<0.05). In the follicular phase group, postoperative serum E2values slightly increased, FSH and LH decreased slightly, the difference was not statistically significant (P>0.05).The mean operative time in the follicular phase group was68.4±5.2min, luteal phase group was72.4±4.8min, the difference of mean operative time between two groups was not statistically significant (P>0.05).In the follicular phase group, the average blood loss was24.3±10.7ml, while that in the luteal phase group was55.5±15.5ml, the difference was statistically significant (P<0.05), luteal phase group tends to more blood loss.Conclusion:The volume of the ovaries in luteal phase was larger than that in the follicular phase.The blood flow around the luteus was rich. Laparoscopic ovarian cystectomy during luteal phase will bring on more bleeding, greater damage to ovarian tissue. The size of ovary will decrease significantly, and it may have an impact on ovarian function.