宋云静 黄俊 徐敏娟

[摘要] 目的 探討腹腔镜下卵巢囊肿蒂扭转复位手术对卵巢囊肿蒂扭转患者生育力保护的临床效果。 方法 回顾性分析2016年11月至2018年11月我院收治的卵巢囊肿蒂扭转患者64例的临床资料，所有患者均采用腹腔镜下卵巢囊肿蒂扭转复位手术进行治疗。统计围术期指标，包括手术出血量、手术时间、住院时间、血栓栓塞并发症发生情况及术后病理类型;统计术前、术后3 d患者D-二聚体水平及D-二聚体异常患者比例;统计术后3个月、1年随访雌激素、孕酮水平正常的患者比例及患侧卵巢功能恢复情况，包括卵巢大小、卵巢血供和卵泡发育正常的患者比例。 结果 患者手术出血量为30～75 mL，平均（51.19±7.83）mL;手术时间为54～92 min，平均（69.35±7.30）min;住院时间为3～7 d，平均（4.64±1.41）d;术后患者均未发生血栓栓塞并发症;术后病理检查均提示良性病变。术前患者的D-二聚体水平为（1.72±0.54）μg/mL、D-二聚体异常患者比例为85.94%，均高于术后3 d的（0.38±0.16）μg/mL、4.69%，差异均有统计学意义（P<0.05）;术后3个月雌激素水平正常的患者比例为93.75%、孕酮水平正常的患者比例为92.19%，与术后1年的95.31%、95.31%比较，差异均无统计学意义（P>0.05）。卵巢囊肿蒂扭转复位手术后，95.31%（61/64）的患者术后1年患侧卵巢血供恢复良好，可见卵泡发育正常;术中卵巢外观呈紫黑色样改变的患者，其卵巢功能恢复比外观红润或暗红者差，差异有统计学意义（P<0.05）。 结论 腹腔镜下卵巢囊肿蒂扭转复位手术安全有效，能较好地保留患侧卵巢功能，保护患者的生育力。

[关键词] 卵巢囊肿;蒂扭转;复位;卵巢功能

[中图分类号] R711.75          [文献标识码] B          [文章编号] 1673-9701（2021）07-0074-04

Clinical efficacy of fertility protection of ovarian cyst pediculotorsion reduction operation

SONG Yunjing   HUANG Jun   XU Minjuan

Department of Gynecology， Ganzhou People′s Hospital in Jiangxi Province， Ganzhou   341000， China

[Abstract] Objective To investigate the clinical efficacy of laparoscopic ovarian cyst pediculotorsion reduction operation on fertility protection of patients with ovarian cyst pediculotorsion. Methods From November 2016 to November 2018， 64 patients with ovarian cyst pediculotorsion admitted to our hospital were selected， and the clinical data of them were retrospectively analyzed. All of them were treated by laparoscopic ovarian cyst pediculotorsion reduction operation. Statistical perioperative indexes， the blood loss， operation time， hospitalization time， thromboembolism complications and postoperative pathology type were included. The level of D-dimer and the proportion of patients with abnormal D-dimer were counted before and 3 days after operation. After 3 months and 1-year follow-up， the proportions of patients with normal estrogen and progesterone levels and the recovery of ovarian function on the affected side were counted. Meanwhile， the proportions of patients with normal ovarian size， ovarian blood supply and follicular development were included. Results The patients′ operation blood loss was 30-75 mL， with average of （51.19±7.83） mL， the operation time was 54-92 min， with average of （69.35±7.30） min， and the hospitalization time was 3-7 days， with average of （4.64±1.41） days. No complications related to thromboembolism were diagnosed after operation and postoperative pathological examinations all showed benign lesions. The level of D-dimer was（1.72±0.54） μg/mL， the proportion of patients with abnormal D-dimer was 85.94% before operation， statistically significant higher than（0.38±0.16） μg/mL and 4.69% 3 days after operation（P<0.05）. the proportion of patients with normal estrogen level was 93.75%， the proportion of patients with normal progesterone level was 92.19%， compared with 95.31% and 95.31% 1-year after operation， there were no significant differences （P>0.05）. After torsion reduction of ovarian cyst pedicle， there was 95.31% （61/64） patients with a good ovarian blood supply 1-year after operation， and a normal development of follicles was shown. The recoveries of ovarian function in patients with purple-black changes during operation were statistically significant worse than those in patients with ruddy or dark red appearance（P<0.05）. Conclusion Laparoscopic torsion reduction of ovarian cyst pedicle is safe and efficacy， which preserves the function of affected side of ovary and protects the fertility of patients.

[Key words] Ovarian cyst; Pediculotorsion; Reduction; Ovarian function

卵巢囊肿蒂扭转可发生于儿童、青少年和育龄期妇女，多由于卵巢囊肿体积较大、瘤蒂长而引起，患者表现为急性下腹部疼痛等[1-2]，其治疗原则为在临床明确诊断后尽快采取手术治疗。既往多采用患侧附件切除术，以避免血栓脱落导致的严重并发症，然而单侧附件切除必然会降低患者的卵巢储备能力，对有生育需求的育龄期妇女影响较大，可能导致不孕[3]。……