The Application Of Laparoscopic Super Pulse Carbon Dioxide ?CO₂? Laser For Treating Ovarian Endometriosis

Objective: By comparing differences of various clinical indicators between super pulse carbon dioxide?CO₂?laser and electric surgical instruments?monopolar and bipolar electrocoagulator?on treating ovarian endometriosis?OEM?,the advantages and disadvantages of each operative instrument are investigated on ovarian function,pain relief,operation time,cost and so on.Then it is aiming at supporting rational clinical alternative.Methods: Thirty patients,aged 20 to 37,were recruited from March2015^November 2015.All experienced laparoscopic surgery in the department of gynaecology in the second hospital of Hebei medical university owing to OEM at ? or ? stage?by revised American fertility score?.They were divided randomly into laser group?n=13?and electric surgical instruments group?n=17?.The exclusion criteria: history of surgery on ovary,abnormal blood lipids,bad hobbies?such as smoking?,usage of gonadropin releasing hormone agonist?GnRHa?or oral contraceptive?OC?for nearly three months.Collecting general information before surgery and sampling blood to determine anti-mullerian hormone?AMH?levels of both two groups at the day before operation,2 days,1 month and 3 months after operation to measure ovarian function.Sampling was stopped when being pregnant or taking GnRHa treatment.When menstruation was recovered after stopping postoperative GnRHa treatment,sampling would go on.The occurrence and treatment of deep infiltrating endometriosis?DIE?were recorded.The preoperative and postoperative pain as well as postoperative pregnancy was recorded.Then some indexes were collected,such as operation time,hospital stay,hospitalization expenses,and hemoglobin levels and so on.Results: When comparing the general indexes between two groups,such asage,marriage and maternity,preoperative hemoglobin levels and AMH levels and so on,there was no statistical difference?P>0.05?,namely the two group were comparable.Compared the AMH levels of all patients before and after surgery.The AMH levels of postoperative 2 days and postoperative 1 month were both statistically lower than preoperative AMH levels?n=30,P<0.05?.When comparing the AMH level of postoperative 2 days to that of postoperative 1 month,there was the statistical difference?n=30,P<0.05?,and the former was higher.Only 16 participants were sampling for 3 months.The AMH levels had a statistically slight rebound at 3 months after surgery comparing to that of postoperative 1 month?n=16,P<0.05?but were still statistical lower than that at postoperative 2 days?n=16,P<0.05?.Comparing the differences of AMH levels before and after surgery between the two groups,the variance of AMH levels before and 2 days after surgery: laser group?n=13?was statistically lower than electric surgical instruments group?n=17??P<0.05?.The variance of AMH levels before and 1 month after surgery: laser group?n=13?and electric surgical instruments group?n=17?had a statistical significance?P<0.05?.There were 7 patients with DIE in laser group.All the Douglas' pouch were unfolded by laparoscopic super pulse CO₂ laser safely without complications.Fifteen patients had symptoms of pain.The postoperative VAS was significantly statistical lower than the preoperative visual analogue scale?VAS??P<0.05?.Seven patients had the pregnancy needs.Two got pregnancy naturally,and one got pregnancy by in vitro fertilization and embryo transfer?IVF-ET?with a follow-up for 3 months.Hospital stay and the variance of hemoglobin before and after surgery had no statistical difference between groups?P>0.05?.While comparison of the operation time and hospitalization expenses between groups,there was statistical difference?P< 0.05?.The laser group was higher.Conclusion:1 By any operative instruments,AMH levels had dropped after the laparoscopic ovarian endometriosis removal surgery,namely ovarian function damaged.While AMH levels at postoperative 1 month were minimum,andthat at postoperative 3 months had a slight rebound.It was speculated that the decline might be linked to the damaged ovarian cortex and affected ovarian blood supply.2 Comparison of the differences of AMH level before and after surgery between groups,the laser group' were lower.So it was assumed that laparoscopic super pulse CO₂ laser might damage ovarian function less.3 Laparoscopic super pulse CO₂ laser could remove the DIE lesion safely and completely with no complications,suggesting that was better than electric surgical instruments.4 Comparing the hemoglobin before and after surgery,there was a statistic decrease.It was assumed that the operation of EM,especially DIE,was difficult and had obvious haemorrhage.However the difference of hemoglobin before and after surgery between groups had no statistical significance,namely the effect of hemostasis of both instruments having no difference.5 The operation time and hospitalization expenses in laser group were higher,so laparoscopic super pulse CO₂ laser has some disadvantages,such as high technical requirement,high cost and long operative time.