Hemostasis by Bipolar Coagulation Versus Suture After Surgical Stripping of Bilateral Ovarian Endometriomas: A Randomized Controlled Trial
Hemostasis by Bipolar Coagulation Versus Suture After Surgical Stripping of Bilateral Ovarian Endometriomas: A Randomized Controlled Trial
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DOI：
10.1016/j.jmig.2012.08.001
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发表时间：
2012-11-01
影响因子：
4.1
通讯作者：
Maggiore, Umberto Leone Roberti
中科院分区：
文献类型：
--
作者：
Ferrero, Simone;Venturini, Pier Luigi;Maggiore, Umberto Leone Roberti
研究目的：评估在接受腹腔镜双侧子宫内膜异位囊肿剥离的不孕妇女中，卵巢缝合在保留卵巢储备方面是否优于双极电凝。设计：随机对照试验（加拿大工作组 I 级）。地点：大学教学医院。患者：100 名双侧子宫内膜异位症患者。干预：患者接受双侧子宫内膜异位症剥离术，并随机接受腹腔镜缝合（LS 组）或双极电凝（BC 组）止血。通过测量术前、术后3、6和12个月的抗苗勒氏管激素（AMH）和基础卵泡刺激素（FSH）水平来研究卵巢储备功能的变化。测量和主要结果：在3个月、6个月和12个月的随访中，两个研究组的术后AMH水平显着低于术前，基础FSH水平显着高于术前。 BC组和LS组在3、6和12个月的随访中AMH水平平均下降百分比没有显着差异。在 3 个月 (p = .023) 和 6 个月随访 (p = .029) 中，BC 组的基础 FSH 平均增加百分比高于 LS 组，但在 12 个月的随访中则不然。两个研究组的妊娠率、受孕时间和子宫内膜异位囊肿复发率相似。结论：腹腔镜卵巢子宫内膜异位囊肿剥离术显着降低血清 AMH 水平并增加基础 FSH 水平，与卵巢组织止血方法无关。微创妇科杂志 (2012) 19, 722-730 (C) 2012 AAGL。版权所有。
Study objective: To estimate whether the suture of the ovary is superior to bipolar coagulation in preserving ovarian reserve in infertile women undergoing laparoscopic stripping of bilateral endometriomas.Design: Randomized controlled trial (Canadian Task Force classification I).Setting: University teaching hospital. Patients: 100 patients with bilateral endometriomas.Interventions: Patients underwent stripping of bilateral endometriomas and were randomized to undergo hemostasis by use of either laparoscopic suturing (LS group) or bipolar coagulation (BC group). Changes in ovarian reserve were investigated by measuring the levels of anti-Mullerian hormone (AMH) and basal follicle-stimulating hormone (FSH) before surgery and at 3, 6 and 12 months from surgery.Measurements and Main Results: At 3-month, 6-month, and 12-month follow-up, in both study groups, postsurgical AMH levels were significantly lower and basal FSH levels were significantly higher than before surgery. There was no significant difference in the mean percentage decrease of AMH levels in the BC group and LS group at 3-, 6-, and 12-month follow-up. The mean percentage increase in basal FSH was higher in the BC group than in the LS group at both 3-month (p = .023) and 6-month follow-up (p = .029), but not at 12-month follow-up. Pregnancy rate, time to conception, and rate of endometrioma recurrence was similar in the 2 study groups.Conclusion: Laparoscopic stripping of ovarian endometriotic cyst significantly decreases serum AMH levels and increases basal FSH levels independent from the method used to obtain hemostasis on the ovarian tissue. Journal of Minimally Invasive Gynecology (2012) 19, 722-730 (C) 2012 AAGL. All rights reserved.