| Objective: The research will lead to benign disease of department of gynaecology surgery treatment and the influence of different surgical methods on ovarian function,at the same time,higher sensitivity and specific laboratory and clinical indicators,to a more objective assessment of the ovarian reserve function after surgery for patients,on the premise of guarantee the operation is safe and effective,the maximum protection of ovarian reproductive and endocrine function,For the country’s fertility policy escort.Methods:1.Clinical data: Sick person who were treated to our hospital from September 2020 to September 2021 due to benign gynecological diseases and planned to be treated by surgery were selected.Meanwhile,patients were randomized block designed for laparoscopic group and open group.Serum specimen collection and determination: After obtaining informed conse nt signed for elective patients with uterine fibroids and ovarian cyst surgery,pre operative menstrual 3 days,3 days for the first time menstruation after operation,postoperative 3 times menstruation take venous blood 3 days are 5 ml in the co agulation tube,electrochemical luminescence method were used to detect and E2,FSH,LH,AMH ELISA method;For ectopic pregnancy or hydrosalpinx,5ml venous blood was sample drawn and storage into a coagulation tube on the third day of menstruation before surgery,the third day of the first menstrual epoch aft er operation,and the third day of the third menstrual period after surgery,AMH was detected by ELISA.2.Statistical survey: General data and laboratory data were collected and analyzed by SPSS 23.0 statistical softwre.Measurement data were expressed as mean ±labeling difference(X ± S),and t was used to test the difference between indicators.P<0.05 was considered statistically significant.Results:All told there were 151 patients with age distribution 25.8±9.2 years and weight of23.45±6.21Kg/m2 were included in the statistics.There are three groups of benign diseases:1.Ovarian cyst group: 66 cases,aged 26.2±8.6 years,body mass index:22.31±5.12Kg/m2,according to the nature of benign cyst group: endometriosis cyst group(30 cases),other cyst group(36 cases): ovarian teratoma 21 cases,simple cyst 6cases,cystic adenoma 9 cases;Two groups were divided according to hemostatic surgical techniques: pure suture hemostasis of ovary(34 cases)and combined electrocoagulation hemostasis(32 cases);According to the size of the cysts,the group with cysts larger than 5cm(35 cases),the group with cysts less than or equal to 5cm(31cases): the diameter of the cysts was 3-5cm,2 cases were endometriosis cysts,and the others were teratoma and cystadenoma.The sick person were classified as unilateral cyst group(42 cases)and bilateral cyst group(24 cases),including 17 cases of endometriosis cyst,4 cases of teratoma and 3 cases of cystadenoma.2.Hysteromyoma group: 42 patients,aged 30.3±4.9 years,body mass index:23.82±5.89Kg/m2,on the basis of uterine fibroids(2017 edition),randomly split them into laparoscopic and open group: open uterine fibroids group(19 cases): Among them,16 cases were multiple uterine fibroids with a number of 3-20 fibroids,and 3 cases were single fibroids with a diameter of 8-10 cm and obvious compression of uterine cavity with severe anemia.Laparoscopic hysteromyoma group(23 cases): There were 1-2myomas with diameters between 4-8cm,all of which were intramural and subserous myomas.3.Fallopian tube group:Forty-three patients,aged 29.3±6.2 years,body mass index:24.22±7.62Kg/m2,were randomly divided into three groups according to different surgical methods: traditional salpingectomy group(10 cases),including tubal pregnancy rupture,severe hydrosalpinx(unilateral or bilateral)and severe pelvic adhesion;Tubal fenestration group(12 cases): all of them had tubal pregnancy without rupture;Tubal core extraction group(21 cases): including hydrosalpinx(unilateral or bilateral),tubal pregnancy without hemorrhagic shock.1 Results of ovarian cyst operation:1.1 Operation indicator between the groupsThe intraoperative blood loss of endometriosis cyst group was(75.66±25.53)m L,which was higher than that of other benign ovarian cysts(51.45+21.79).Co mparison between groups,the operation treatment time of endometriosis cyst gro up(63.26±12.75)min was longer than that of other ovarian tumor group(52.89±10.52)min.Difference of Anal exhaust time between the two groups is unobvious.Among them,2 cases of ectopic intrauterine cyst group showed postoperative fev er,which was cured after prolonged antibiotic use,while the other patients had no complications.1.2 Comparison of AMH,FSH,LH and E2 levels before and after operation for different benign ovarian cystsIntra-group comparison showed that the AMH values of the endometriosis cyst group were different before and after operation,while FSH,LH and E2 showed no significant difference in comparison with those before surgery.AMH was significant in the first postoperative menstrual period,and the AMH of the third menstrual period after operation showed a recovery upward trend,with significant statistical significance(P<0.01).In other benign ovarian cyst groups,postoperative AMH decreased,and the difference was significant(P<0.05),in comparison with before and after,FSH、LH and E2,there were no significant difference.The AMH level of the endometriosis cyst group was lower than that of the other benign ovarian cyst groups before surgery,the difference was significant(P<0.05),while FSH,LH and E2 levels had no statistical difference.The AMH level of the endometriosis cyst group in the third menstrual period after surgery was lower than that of the other ovarian cyst group.there was significant difference between them(P<0.01),and the comparison between FSH,LH and E2 was also statistically significant(P<0.05).1.3 The levels of AMH,FSH,LH and E2 were compared between the ovarian suture hemostasis group(group A)and the combined electrocoagulation hemostasis group(group B)Intra-group comparison indicated that the standards of FSH,LH and E2 in group A and GROUP B has no significantly different before and after operation(P>0.05).The AMH in the first and third menstruation after operation in group A and GROUP B was lower than that before operation,and the decrease of the first menstrual period after operation was more significant,the difference was statistically significant(P<0.05).Preoperative comparison between groups showed there were no statistically differences in AMH,FSH,LH and E2 results between the two groups.The AMH of group B was less than group A in the first and third menstruation after surgery,and the difference was statistically significant(P<0.05),while FSH,LH and E2 levels was no significant difference.1.4 The levels of AMH,FSH,LH and E2 were compared between the group with more than 5cm cyst(group C)and the group with less than or equal to 5cm cyst(group D)Intra-group comparison showed that AMH in the first and third postoperative menstruation of group C and D lowered compared with pre-operation.The differe nce was statistically significant(P<0.01);FSH,LH and E2 in group C indicated no significant changes,while group D showed statistically significant differences(P<0.05).That comparison in preoperative,AMH was no statistically significant differe nce,and the first and third menstruation after surgery in group C was lower tha n group D,with statistically significant difference(P<0.05).Comparison between the two groups after surgery,There was no significant difference in FSH,LH and E2 levels.1.5 Comparison of effects of unilateral and bilateral ovarian cysts on AMH,FSH,LH,E2Intra-group comparison showed that AMH decreased significantly in the first and third menstrual periods after surgery compared with that before surgery(P<0.01),and AMH decreased more in the first menstrual period after surgery.FSH,LH and E2 showed statistically significant differences compared with that before surgery.Comparied inilateral AMH,FSH,LH and E2 levels with bilateral before sur gery,That was no statistically significant differences.but bilateral AMH decrease d more in the first and third menstruation after operation,The difference between the two was statistically significant(P<0.05).2 Results of uterine fibroids2.1 Operation indicator between the groupsThe operative blood loss in the laparoscopic group was(83.40±19.20)m L,significantly less than that in the open uterine fibroid group(148.70±21.40)ml,with statistical significance(P<0.05).The operative time between the two groups was no statistically significant difference.The postoperative anal exhaust time in the laparoscopic group was(26.40±17.80)h,which was shorter than that in the open group(32.40±18.20)h,and the difference was statistically significant Comparison of complications after the operation between the two groups: 1 case of fat liquefaction and1 case of pelvic infection occurred in the open group,and 1 case of postoperative fever occurred in the laparoscopic group,which were cured after symptomatic treatment.2.2 The results of AMH,FSH,LH and E2 in two groups before and after operation were comparedIntra-group comparison,AMH in the laparoscopic group decreased in the first menstrual period after surgery,with statistical significance(P<0.05),while AMH decreased slightly in the third menstrual period after surgery,but the difference was not statistically significant.There were no significant differences in FSH,LH and E2 levels before and after surgery.In the open group,AMH decreased in the first menstruation after operation,and the difference was statistically significant(P<0.05),while there was no significant difference in AMH in the third menstrual period after surgery compared with that before surgery.There were no significant differences in the above indicators between the tw o groups before treatment.The AMH level in the first menstrual period after sur gery in the laparoscopic group was slightly less than that in the open surgery gr oup,with statistically significant differences(P<0.05),while between the two gro ups,the AMH level in the third menstrual period after surgery showed no statist ically significant differences.3 Results of fallopian tube3.1 Comparison of surgical indexesThe operative blood loss and postoperative anal exhaust time between the three groups was no significant difference.Compared with the core-extraction group and the fenestration group,the surgery time of the traditional salpingectomy group was shorter.the difference was statistically significant(P<0.05).There were no postoperative complications in the three groups.3.2 Comparison of preoperative and postoperative AMH among three groupsIntra-group comparison: In the core-extraction group,AMH value decreased slightly in the first and third menstruation after surgery,but the difference was not statistically significant.,Also in AMH levers between the first and third menstrual periods in the fenestration group.In the traditional resection group,both postoperative the first and the third menstruation declined,and the otherness was statistically significant(P<0.05).There was no obviously otherness in AMH value between the above three groups before treatment,and the level of AMH in the first and third menstruation after surgery in the core extraction group and the fenestration group was better than that in the traditional surgery group,it has statistical significance(P<0.05).Conclusion:1.Laparoscopic ovarian cyst removal can lead to decreased ovarian AMH secretion ability,and endometriosis cyst has a greater impact on AMH level,and the change of AMH after surgery is earlier than FSH,LH and E2.During the operation,electrocoagulation was used to further affect ovarian function.For laparoscopic ovarian cyst,The influence of bilateral on ovarian function was more obvious than unilateral.The decrease of AMH was more obvious for cysts larger than 5cm in diameter.Therefore,the larger the cyst increased the negative effects on the reproductive and internal secretion function of the ovary after operation.2.Laparoscopic uterine fibroids rejecting operation and laparotomy for patients AMH all affect the short term,postoperative march can be basically recovered to preoperative levels,no significant effect on FSH,LH,E2,overall effect on ovarian function,less bleeding,fewer pelvic disturbance due to surgery,laparoscopic surgery is beneficial to patients recover at an early date,compared with open operation,much better than the former.3.Laparoscopic tubal operation is an effective therapeutic schedule of tubal pregnancy and hydrosalpinx.At the same time,it separates pelvic adhesions,improves pelvic microenvironment and provides help for future pregnancy.Tubal removal by core-pulling and tubal fenestration had little effect on AMH.AMH decreased after traditional resection,which had a certain influence on ovarian function.4.AMH is more sensitive in the judgment of ovarian function,and its changes are earlier than FSH,LH and E2,and it is less affected by menstrual cycle changes,so it is convenient to detect and has more clinical practical value. |
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