背景:评估在良性和非子宫内膜异位卵巢肿瘤的经阴道自然口卵巢囊肿切除术(TNOOC)中使用人纤维蛋白胶(Tisseel)控制少量出血和接近卵巢缺损。
方法:共125例良性和非子宫内膜异位卵巢肿瘤患者在2011年5月至2020年1月期间接受了TNOOC:54例在Tisseel的帮助下,71例采用传统缝合止血和接近卵巢缺损。手术结果,如手术长度,手术失血,术后疼痛评分,记录术后住院时间。在手术之前和立即(10天)以及手术后6个月,还测定了血清抗苗勒管激素(AMH)水平。
结果:所有病例均达到完全止血和接近卵巢缺损。手术时间没有显著差异,手术失血,术后12、24和48h疼痛评分,术后住院时间,两组之间的基线AMH水平。手术对缝合组术后即刻和术后6个月的AMH水平没有负面影响。然而,Tisseel组的AMH水平在手术后立即显著下降,然而,6个月时AMH水平无显著差异(3.3vs.1.7mg/mL;p=0.042,调整后p=0.210)。
结论:在良性和非子宫内膜异位卵巢肿瘤的TNOOC中使用Tisseel而不缝合卵巢组织是临床安全可行的。
BACKGROUND: To evaluate the use of a human fibrin glue (
Tisseel) for minor bleeding control and approximation of ovarian defect during transvaginal natural orifice ovarian cystectomy (TNOOC) of benign and non-endometriotic ovarian tumors.
METHODS: A total of 125 women with benign and non-endometriotic ovarian tumors who underwent TNOOC between May 2011 and January 2020: 54 with the aid of
Tisseel and 71 with traditional suture for hemostasis and approximation of ovarian defect. Surgical outcomes such as length of surgery, operative blood loss, postoperative pain score, and postoperative hospital stay were recorded. Before and immediately (10 days) and at 6 months after the procedure, serum anti-Müllerian hormone (AMH) levels were also determined.
RESULTS: Complete hemostasis and approximation of ovarian defect were achieved in all cases. No significant difference was noted in the operating time, operative blood loss, postoperative pain scores after 12, 24 and 48 h, length of postoperative stay, and baseline AMH levels between the two groups. The operation did not have a negative effect on the immediate and 6-month postoperative AMH levels in the suture group. However, the decline in the AMH levels was significant immediately after surgery in the
Tisseel group, nevertheless, no significant difference was noted in the AMH levels at 6 months (3.3 vs. 1.7 mg/mL; p = 0.042, adjusted p = 0.210).
CONCLUSIONS: The use of
Tisseel in TNOOC of benign and non-endometriotic ovarian tumors without suturing the ovarian tissue is clinically safe and feasible.