Effect On Ovarian Reserve Of Laparoscopic Versus Laparotomic During Unilateral Ovarian Benign Tumor Cystectomy In Short Term

ObjectiveTo compare the effects of laparoscopy with laparotomic during unilateral ovariancystectomy on the ovarian reserve in short term.Methods(1) A Prospective comparison trial was conducted on61women with unilateralovarian benign tumor but not endometrioma. We divided the objects into laparoscopicbipolar electrocoagulation group（group A, n=32） and Laparotomic hemostatic suturesgroup (group B, n=29) according to patients，requirements, and again divided theobjects into18-30years old group (group G1, n=32),31-35years old group (group G2,n=22) and36-40years old group (group G3, n=7) according to the age, and againinto <5cm group (group C1, n=16),≥5cm group (group C2, n=45) according to thetumor diameter size.(2) Blood samples of the objects in laparoscopic bipolar electrocoagulationgroup（n=32） and laparotomic hemostatic suturing group (n=29) at at day3of themenstrual cycle during preoperative (T0), postoperative1month (T1)andpostoperative3month (T2) were measured by AMH ELISA.(3) AFC、 PSV、RI of the operated and non-operated ovaries of the objects ingroup A（n=32）and group B (n=29) were evaluated by transvaginal ultrasound at day3of the menstrual cycle during postoperative1month (T1)and postoperative3month (T2);and menstruation of the objects in group A（n=32）and group B (n=29) was followed upfor3month.Results(1) Preoperative Serum AMH levels did not differ significantly between A and B groups(3.86±0.55vs4.06±0.63; P>0.05). the Serum AMH level of the objects in groupA is significantly lower than that in group B (3.36±0.50vs3.85±0.43;3.68±0.51vs3.95±0.49,P<0.05) At T1and T2. there was a significant decrease in Serum AMHlevels In the A group at T1and T2(3.36±0.50vs3.86±0.55,P<0.05;3.68±0.51vs3.86±0.55, P<0.05), comparing with T0. In the A group, the Serum AMH level At T2issignificant higher than that at T1. In the B group, no significant difference in AMHlevels were detected at T0,T1and T2（3.85±0.43,3.95±0.49,4.06±0.63, P>0.05).(2) The preoperative AMH levels were negative correlated to the age(R=－0.67，P＜0.001). There was a significant decrease in AMH levels in the group G2and G3compared with G1(3.783±0.412vs4.179±0.629, P<0.05；3.325±0.326vs4.179±0.629, P<0.05)，with a significant decrease in the G3group compared with the G2group（3.783±0.412vs3.325±0.326，P<0.05）.(3) The serum AMH levels of patients in the C1group is significantly higher thanthat in the C2group (4.49±0.48vs3.74±0.51, P<0.05).(4) The AFC、PSV、RI of the operated and non-operated ovaries of the objects ingroup A and group B at T1and T2：in the groupA，theAFC、PSV of the operated sideovaries are significantly lower than the non-operated side ovaries at T1and T2(6.0±1.85vs8.84±2.94;8.73±2.51vs11.57±2.89, P<0.05), but the RI of the operated sideis significantly higher than that in the non-operated side ovaries (0.63±0.08vs0.56±0.1, P<0.05). in the group B，the AFC、PSV、RI of the operated side ovaries is notsignificantly different compared with the non-operated side ovaries at T1and T2. TheAFC、PSV of the operated side ovaries in the A group is significantly lower than that ofthe operated side ovaries in B group, but the RI is significantly higher. The AFC、PSV、RI of the non-operated ovaries of the objects in the group A and B is not significantlydifference at T1and T2(8.84±2.94vs8.62±2.96，P>0.05；11.57±2.89vs11.24±2.15，P>0.05；0.56±0.1vs0.55±0.11，P>0.05).(5) Compared with T1,the AFC and PSV levels of the operated side ovaries in the Agroup is significantly higher at T2，and the RI levels is significantly higher at T2(0.59±0.09vs0.55±0.04, P<0.05). But in the B group,the AFC、PSV、RI of the operated side ovaries is not significantly difference at T1and T2(8.66±3.13vs8.9±2.83，P>0.05；12.06±2.40vs11.92±2.87，P>0.05；0.55±0.04vs0.53±0.07，P>0.05).(6) only one patient in laparoscopic group has abnormal menstruation, no patientin Laparotomic group has abnormal menstruation. there is no significantly differencebetwen the laparoscopic group and Laparotomic group(P>0.05)Conclusion（1） The SerumAMH joint ultrasonic Doppler parametersAFC, PSV, RI can be betterto assess ovarian reserve function（2）The preoperative AMH levels of unilateral ovarian benign tumor were negativecorrelated to age.（3）the size of ovarian cyst affects the serum AMH levels of patients,that in the cyst≥5cm group is significantly less than that in the cyst <5cm group（4）Laparoscopic stripping of unilateral ovarian benign tumor is associated with asignificant reduction in ovarian reserve in short term，but there is a certain degreerecovery at the3rd postoperative cycle. Laparotomic stripping of unilateral ovarianbenign tumor does not affect the ovarian reserve.