| Objective: By comparing preoperative,intraoperative and postoperative differences of various clinical indicators between hydrodissection with diluted pituitrin and electro surgical instruments(monopolar and bipolar electrocoagulator),two ways of cystectomy for ovarian endometriosis cyst(Ovarian Endometriosis cyst,OEMC),to investigate the efficacy and effect of two surgical methods on ovarian function in laparoscopic cystectomy of ovarian endometriosis.Methods: Thirty patients were recruited from March 2016-November2016,who experienced laparoscopic surgery in the department of gynaecology in the second hospital of Hebei medical university owing to OEMC.They were randomly divided into hydrodissection group(n=11)and electric surgical instruments group(n=19).Patients were collected general information before surgery and were compared between the two groups in age,diameter of cyst,amount of bleeding during operation;The preoperative and postoperative pain score as well as postoperative pregnancy was recorded.Sampling peripheral venous 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 evaluate the effects of operation on ovarian function.Sampling was stopped when postoperative pregnancy or taking Gn RHa treatment.If the treatment of Gn RHa was stopped and menstruation was recovered,sampling would go on.Results: Firstly we compared the general indexes between two groups such as age,cyst size,r-AFS score,side,preoperative hemoglobin(Hb)and AMH levels and so on,which had no significant difference(P>0.05),comparable.Then we compared the the AMH levels in two groups before and after surgery.Follow-up period of 1 month in hydrodissection group,the AMHlevel of postoperative 2 days and postoperative 1 month were decreased than preoperative(n=11,P < 0.05),postoperative 1 month was increased than postoperative 2 days(n=11,P < 0.05),when 3 months after surgery the AMH level was more increased(n=7,P < 0.05),there were statistical difference.Similaly there were statistical difference in electrical group,the AMH level of postoperative 2 days and postoperative 1 month were decreased than preoperative and postoperative 1 month was lower(n=19,P < 0.05),when 3 months after surgery the AMH level was little increased than postoperative 2 days(n=13,P < 0.05).However,there was no significant difference in AMH level between the two groups(n=30,P >0.05;n=20,P>0.05).Lastly separately comparing the changes of pain visual analogue score(Visual Analogue Scale,VAS)and Hb in two groups before and after surgery,which were statistically significant decrease(P < 0.05),but the two groups had no significant difference(n=30,P > 0.05).There were 11 patients want to be mother in two groups,2 patient had a natural pregnancy and 1 patient was pregnant with the help of artificial reproductive techniques when finishing.The ovarian function of 2 patients in hydrodissection group(aged 36 and 37 years old)had decreased to the level of menopause after the operation.Conclusion:1 Ovarian function will be damaged after laparoscopic ovarian endometriosis removal surgery,no matter what kind of surgery.Although it can recover slowly as time goes on,but still not exceed the preoperative level.2 Comparing the changes of ovarian function before and after the operation in the hydrodissection group and the electrical group,there was no significant difference which showed that the two kinds of surgical methods had no difference in the damage of the ovarian function.3 There was statistically significant difference of VAS and Hb before and after the operation,suggesting that ovarian endometriosis removal surgery is difficult,more intraoperative bleeding and can effectively improve the dysmenorrhea,but there was no statistical difference in two groups which showed that two kinds of surgical remission had no difference in stoppingpain and bleeding. |
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