保守性和根治性手术治疗对卵巢良性肿瘤蒂扭转的疗效和术后激素水平比较

目的:观察保守性和根治性手术治疗卵巢良性肿瘤蒂扭转的有效性和安全性。方法:选取2017年2月~2020年5月间入院治疗的60例确诊为卵巢良性肿瘤蒂扭转的患者,根据患者意愿及病情发展情况分为两组,保守治疗组26例,切除治疗组34例。保守性手术组(The conservative operation group,COG)术前应根据患者的疼痛性质判断扭转组织的基本情况制定多套方案,术中先以钳夹等方式结扎卵巢动静脉以免形成栓塞,然后进行扭转复位并观察血流恢复情况,待恢复接近正常时可剥离囊肿。切除治疗组(The radical operation group,ROG)结扎卵巢动静脉,将扭转蒂复位观察卵巢颜色、质地等,若出现破裂、坏死、无法恢复等情况时给予切除。比较两种治疗方法前后患者血清黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle-stimulating hormone,FSH)、雌二醇(Estradiol,E2)等变化,评估卵巢的激素分泌情况,并记录其他并发症的发生率。结果:(1)保守性治疗组卵巢均成功保留,两组患者均恢复良好,比较两组患者的平均手术时间、术中出血量及住院时间,结果显示无统计学差异(P>0.05);(2)随访半年,比较术前,术后3个月、6个月两组患者LH、FSH、E2的变化情况,术前各指标无显著差异(P>0.05);(3)比较两组患者术中并发症发生率,无显著差异(P>0.05)。结论:本研究比较了保守性手术和切除手术治疗卵巢肿瘤蒂扭转的有效性与安全性,26例保守性治疗患者手术卵巢均保留成功,预后卵巢功能、并发症的发生率与切除治疗组无显著差异,可进行临床推广。

The Effect of Conservative and Radical Operation on Benign Ovarian Porsion and Comparison of Postoperative Hormone Levels

ABSTRACT Objective: To observe the efficacy and safety of conservative and radical operation for the benign ovarian torsion. Methods: To observe sixty patients diagnosed as the benign ovarian torsion from February 2017~ May 2020, the patients were divided into two groups according to their wishes and the development of the disease. There were 26 cases in the conservative operation group and 34 cases in the radical operation group. The conservative operation group should be estimated the basic conditions for ovarian torsion to develop different plans by the nature of the patient''s pain. During operation, we ligate ovarian arteries and veins to avioding embolization, then resetting twisted ovarianand observing the recovery of blood flow. The cyst can be exfoliated when the recovery is close to normal. If the situation of the radical operation group cannot recover, the ovary will be cutted. The changes of serum LH, FSH, E2 were compared between the two treatments, to evaluate the secretion of ovarian hormones, and to record the incidence of other complications. Results: The ovarys were preserved successfully in the conservative treatment group, and both groups recovered well. The average operation time, intraoperative blood loss and hospital stay of the two groups were compared, and the results showed no statistical difference (P>0.05). To compare the changes of LH, FSH and E2 in the two groups when it was preoperative, postoperative 3 month, postoperative 6 month, there were no significant difference in the preoperative (P>0.05). There was no significant difference in the incidence of intraoperative complications between the two groups (P>0.05). Conclusion: In this study, the efficacy and safety of conservative operation and radical operation on the benign ovarian torsion were compared. All the 26 patients with conservative treatment had their ovaries preserved successfully, There was no significant difference in the prognosis of ovarian function and the incidence of complications, which could be used for clinical promotion.