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Objective@#To investigate the protective effect of laparoscopic water separation and removal combined with suture hemostasis on ovarian reserve function after bilateral ovarian endometriotic cyst (OEC) stripping.@*Methods@#From January 2016 to January 2018, 60 patients with bilateral ovarian endometriosis cystectomy underwent laparoscopic surgery in the Department of Obstetrics and Gynecology, Jiading Hospital of traditional Chinese medicine.According to the random number table method, they were divided into study group (water separation and stripping combined suture hemostasis group) and the control group (direct stripping combined with electrocoagulation hemostasis group), 30 cases in each group.The changes of operation time, hemoglobin level before and after operation and the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti Mullerian hormone (AMH) were compared between the two groups.@*Results@#There was no significant difference in operation time (47.52 ±10.11) min, hemoglobin decrease (0.55 ±0.26) g/L, hospital stay (6.1 ±0.3) d, control group (48.01 ±10.24) min, hemoglobin decrease (0.56 ±0.25) g/L and hospitalization time (6.2 ±0.4) d before and after operation (t=0.056, 0.964, 0.863, all P>0.05). The levels of FSH, E2, LH and AMH in the study group before operation were (6.15 ±2.31) U/L, (152.41 ±41.40) nmol/L, (5.44 ±1.52) U/L and (2.21 ±0.13) μg/L, respectively.One month after operation, they were(6.21±2.24) U/L, (150.63±40.33) nmol/L, (5.13±1.58) U/L, (2.18±0.16) μg/L, respectively.Three months after operation, they were (6.52±2.41) U/L, (149.57±42.37) nmol/L, (5.30±1.45) U/L, (2.17± 0.15) μg/L, respectively.Six months after operation, they were (6.53±2.44) U/L, (151.36±41.54) nmol/L, (4.98±1.61) U/L, (2.20±0.08) μg/L, respectively.The levels of FSH, E2, LH and AMH in the control group before operation were (6.14±2.21) U/L, (153.31±40.39) nmol/L, (5.51±1.46) U/L, (2.23±0.13) μg/L, respectively.One month after operation, they were (8.11±2.44) U/L, (131.43±41.23) nmol/L, (5.92±1.64) U/L, (1.58±0.14) μg/L, respectively.Three months after operation, they were (8.42±2.35) U/L, (135.67±40.38) nmol/L, (6.12±1.51) U/L, (1.54±0.16) μg/L, respectively.Six months after operation, they were (9.17±2.64) U/L, (133.66±40.44) nmol/L, (6.28±1.74) U/L, (1.51±0.13) μg/L, respectively.There was no significant difference in the levels of FSH, E2, LH and AMH between the two groups (all P>0.05). There was significant difference between the preoperative FSH level and the postoperative 1, 3, 6 months in the control group (all P<0.05); there was significant difference between the preoperative E2 level and the postoperative 1 month in the control group (P<0.05); there was statistical significance between the preoperative AMH level and the postoperative 1, 3 months in the control group (all P<0.05). The levels of FSH, LH, E2 and AMH in the study group were significantly higher than those in the control group (all P<0.05).@*Conclusion@#Laparoscopic hydrodissection combined with suture hemostasis does not increase the operation time and the amount of bleeding, and does not affect the ovarian reserve function after operation.
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Objective To investigate the changes and clinical significance of Treg and Th17 cells in patients with ovarian endometrioma (OEM) pre-and post-laparoscopy.Methods 36 patients with OEM undergoing laparoscopic surgery and confirmed by the pathology were enrolled as the experiment group,and 25 patients with fallopian tube obstruction who received laparoscopic examination were enrolled as the control group.The peripheral blood samples were collected from the control group and the experiment group before operation as well as from the experiment group 3 months after operation.Intraoperative peritoneal fluid were also collected from both groups.The levels of IL-17,IL-22,IL-23,IL-10 and TGF-β in serum and peritoneal fluid were detected by ELISA.The proportion of Treg and Th17 cells in peripheral blood was detected by flow cytometry.Results Compared with the control group,the levels of IL-17,IL-22 and IL-23 in the peritoneal fluid and serum of the experiment group increased significantly,while the levels of IL-10 and TGF-β were significantly decreased (P＜0.05).The proportion of Th17 cells in the peripheral blood of the experiment group increased significantly,and the proportion of Treg cells decreased significantly (P＜0.05).Compared with pre-laparoscopic treatment,the serum IL-17,IL-22 and IL-23,and the proportion of Th17 cells in peripheral blood were significantly decreased in the experiment group,and the levels of IL-10 and TGF-β in serum increased significantly (P＜0.05).Conclusions In patients with OEM,Treg and Th17 cell imbalance and the expression of related cytokines in disorder may be an important factor in the occurrence and development of disease.Detection of Treg/Th17 cells and their cytokines plays an important role in evaluating the severity of the disease and judging the efficacy of laparoscopic treatment and prognosis of OEM.
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Objective To evaluate the effects of electric coagulation or suture hemostasis on ovarian reservation function in laparoscopic ovarian cyst removal for ovarian endometriomas. Methods A total of 118 patients receiving laparoscopic ovarian cystectomy in our hospital from January 2011 to June 2015 were enrolled in this study.According to the habit of different operators,the patient were devided into either electric coagulation group(n =53)or suture group(n =65).The follicle-stimulating hormone (FSH),luteinizing hormone(LH),estradiol(E2)and antral follicle count(AFC)of the two groups were observed and compared before surgery and one and six months after surgery. Results There were no differences in the levels of the FSH,LH,E2and AFC between the two groups before the surgery(P>0.05).The level of FSH was increased and those of E 2and AFC were declined in both groups at 1 month after the operation compared with those before operation(P <0.05).Moreover, there were more significant differences in FSH,E2,and AFC in the electric coagulation group(P <0.05).There was no significant difference in LH(P>0.05).The levels of FSH and E 2recovered in both groups at 6 months after operation.There was no difference in FSH and E 2 compared with the level before operation in the suture group(P>0.05), however, there was significant difference in the electric coagulation group(P<0.05). Conclusions The laparoscopic ovarian cystectomy for ovarian endometriomas leads to decreased ovarian reserve.As compared to bipolar coagulation, suture hemostasis can effectively reduce the damage of ovarian function, which should be applied as possible as we can.
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Objective To evaluate the effects of electric coagulation or suture hemostasis on ovarian reservation function in laparoscopic ovarian cyst removal for ovarian endometriomas. Methods A total of 118 patients receiving laparoscopic ovarian cystectomy in our hospital from January 2011 to June 2015 were enrolled in this study.According to the habit of different operators,the patient were devided into either electric coagulation group(n =53)or suture group(n =65).The follicle-stimulating hormone (FSH),luteinizing hormone(LH),estradiol(E2)and antral follicle count(AFC)of the two groups were observed and compared before surgery and one and six months after surgery. Results There were no differences in the levels of the FSH,LH,E2and AFC between the two groups before the surgery(P>0.05).The level of FSH was increased and those of E 2and AFC were declined in both groups at 1 month after the operation compared with those before operation(P <0.05).Moreover, there were more significant differences in FSH,E2,and AFC in the electric coagulation group(P <0.05).There was no significant difference in LH(P>0.05).The levels of FSH and E 2recovered in both groups at 6 months after operation.There was no difference in FSH and E 2 compared with the level before operation in the suture group(P>0.05), however, there was significant difference in the electric coagulation group(P<0.05). Conclusions The laparoscopic ovarian cystectomy for ovarian endometriomas leads to decreased ovarian reserve.As compared to bipolar coagulation, suture hemostasis can effectively reduce the damage of ovarian function, which should be applied as possible as we can.
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Rupture of ovarian endometrioma is rarely occurred. It causes chemical panperitonitis resulting in low fertility and requiring differential diagnosis of acute abdomen. So it needs fast and accurate diagnosis. We have experienced two cases of chemical panperitonitis due to ruptured ovarian endometrioma managed by pelviscopy with a brief review of the literature.
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Feminino , Abdome Agudo , Diagnóstico , Diagnóstico Diferencial , Endometriose , Fertilidade , RupturaRESUMO
0.05).The pregnancy rate was 41.5%(17/41) in the(Non-cystectomy) Group,33.3%(23/69) in the Laparoscopic Group,and 25.5%(14/55) in the Open Group,respectively,without significant differences(?~2=2.754,P=0.252).A total of 86 patients(90 cycles) were given a unilateral cystectomy,including 37 cycles in the Open Group and 53 cycles in the Laparoscopic Group.In the 37 cycles of the Open Group,the number of dominant follicles was less in affected ovary(4.41?4.02) than in contralateral one(6.14?4.37)(t=-2.364,P=0.024),whereas in the 53 cycles of the Laparoscopic Group,the number of dominant follicles was significantly less in affected ovary(3.33?3.50) than in contralateral ovary(6.40?3.61)(t=-5.358,P=0.000).Conclusions Both laparoscopic and open cystectomy of ovarian endometrioma may cause damage to ovarian response of COH.