Effect on Ovarian Reserve of Hemostasis by Bipolar Coagulation Versus Suture During Laparoendoscopic Single-Site Cystectomy for Ovarian Endometriomas
Effect on Ovarian Reserve of Hemostasis by Bipolar Coagulation Versus Suture During Laparoendoscopic Single-Site Cystectomy for Ovarian Endometriomas
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DOI：
10.1016/j.jmig.2014.11.002
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发表时间：
2015-03-01
影响因子：
4.1
通讯作者：
Kim, Kye Hyun
中科院分区：
文献类型：
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作者：
Song, Taejong;Kim, Woo Young;Kim, Kye Hyun
研究目的：比较腹腔镜下卵巢子宫内膜异位瘤单部位膀胱切除术（LESS-C）中双极凝固止血与缝合止血对卵巢储备功能的影响。设计：前瞻性比较研究（加拿大特别工作组分类II-1）。患者：125例卵巢子宫内膜异位瘤患者。干预措施：子宫内膜异位瘤患者在LESS-C期间采用双极凝固止血（n = 62）或缝合止血（n = 63）。我们通过测定所有患者术前和术后3个月的血清抗米氏激素（AMH）水平来评估手术对卵巢储备的影响。测量和主要结果：年龄、子宫内膜异位瘤的双侧性、术前AMH水平等基线特征在两个研究组之间相似。两组在手术时间、手术出血量、手术并发症等手术结果上也无差异。两组患者术后AMH水平均低于术前（p < 0.001）。双极凝固组AMH水平下降率显著高于缝合组（42.2%[四分位数范围，16.5% ~ 53.0%]和24.6%[四分位数范围，11.6% ~ 37.0%],p = .001）。结论：根据AMH序列水平，LESS-C期间子宫内膜异位瘤剥离后双极凝固止血比缝合止血更能减少卵巢储备。因此，在卵巢子宫内膜异位瘤剥离后，缝合可能是较好的止血选择。(c) 2015年。版权所有。
Study Objective: To compare the postoperative decrease in ovarian reserve between hemostasis by bipolar coagulation and suture during laparoendoscopic single-site cystectomy (LESS-C) for ovarian endometriomas.Design: Prospective comparative study (Canadian Task Force Classification II-1)Setting: University hospital.Patients: One hundred twenty-five patients with ovarian endometriomas.Interventions: Patients with endometrioma were managed by hemostasis with either bipolar coagulation (n = 62) or suturing (n = 63) during LESS-C. We evaluated the impact of surgery on ovarian reserve using serum anti-Miillerian hormone (AMH) levels, which were measured before surgery and 3 months after surgery in all patients.Measurement and Main Results: Baseline characteristics such as age, bilaterality of endometriomas, and preoperative AMH levels were similar between the 2 study groups. There were also no differences between the 2 groups in surgical outcomes, such as operative time, operative blood loss, or operative complications. In both study groups, postoperative AMH levels were lower than preoperative AMH levels (p < .001). The decline rate of AMH levels was significantly greater in the bipolar coagulation group than in the suture group (42.2% [interquartile range, 16.5%-53.0%] and 24.6% [interquartile range, 11.6% 37.0%], respectively, p = .001).Conclusion: Hemostasis by bipolar coagulation after stripping of the endometrioma during LESS-C reduces ovarian reserve more than suturing does, as determined by serial AMH levels. Therefore, suturing may be a better hemostatic choice after stripping ovarian endometriomas. (C) 2015 AAGL. All rights reserved.