子宫内膜异位症手术治疗后复发相关因素的分析  

Analysis of relative factors influencing recurrence of endometriosis after operation treatment

作　　者：赵轩[1] 刘俊丽[1] 陈世荣[1] 刘毅[1] 

机构地区：[1]遵义医学院附属医院妇产科,563003

出　　处：《中华妇产科杂志》2006年第10期669-671,共3页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨子宫内膜异位症（内异症）术后复发的相关因素.方法 对356例内异症手术治疗患者随访3年,将其中复发的75例患者的临床资料进行回顾性分析,对可能引起复发的相关因素（年龄、临床病理类型、分期、手术方式、术后是否加用米非司酮）进行分析.结果 年龄≤24岁患者的复发率为0,与其余4个年龄段（25～29、30～34、35～39、≥40岁,复发率分别为19.8%、19.8%、31.9%和21.6%）比较,差异有统计学意义（χ^2=11.212,P＜0.05）;年龄与复发率有相关关系（P＜0.05）.在临床病理类型中,混合型、深部结节型患者的复发率分别为29.2%、33.3%,前者明显高于卵巢型的17.5%（χ^2=4.622,P=0.032）;复发率与临床病理类型有相关关系（P＜0.05）.复发率随着内异症分期的增高而增加（P＜0.05）;Ⅰ～Ⅱ、Ⅲ、Ⅳ期患者的复发率分别为12.9%、22.5%、55.6%,Ⅰ～Ⅱ期与Ⅲ、Ⅳ期患者的复发率分别比较,差异均有统计学意义（χ^2=5.129,χ^2=33.899,P均＜0.05）.Ⅲ期内异症患者腹腔镜手术与开腹手术的术后复发率分别为31.3%、11.3%,两者比较,差异有统计学意义（χ^2=7.971,P=0.005）.加用米非司酮患者的复发间隔时间为（13±4）个月,未用药患者的复发间隔时间为（7±3）个月,两者比较,差异有统计学意义（t=4.575,P＜0.01）.结论 内异症的治疗应根据患者年龄、临床病理类型、分期选用创伤小并能较彻底清除病灶的个体化治疗方案.术后短期应用抑制卵巢功能的药物可延长复发间隔时间.Objective To explore the relative factors influencing the recurrence of endometriosis. Methods Three hundred and fifty-six patients of endometriosis were treated with surgery and then followed up for 3 years. Seventy-five recurrent cases among them were analyzed retrospectively. Results The recurrent rate was different in the ≤24 year age group （χ^2 = 11. 212, P 〈 0.05 ）, while there was no difference in the other age groups. According to pathological type, the recurrent rate of mixed pattern （29. 2% ） was significantly higher than that of the simple chocolate cyst （ 17.5% ; χ^2 = 4. 622, P 〈 0. 05 ）. The higher the clinical stage of the endometriosis, the higher the recurrent rate （ P 〈 0. 05 ）. The recurrent rate of endometriosis in the third stage was different between laparoscopy and laparotomy （31.3% vs 11.3% ; χ^2 = 7. 971, P 〈 0.01 ）. Mifepristone could prolong the interval of recurrence after operation [ （ 13±4） vs （7±3） months; t =4. 575, P 〈 0. 01 ]. Conclusions Individualized therapeutic regimen should be made in treatment of endometriosis according to age, pathological type, and clinical stage. The recurrent rate could be reduced and the interval of recurrence could be prolonged using ovarian function inhibiting drugs for a short time post-operation.

关 键 词：子宫内膜异位症 妇科外科手术 复发 

分 类 号：R713[医药卫生—妇产科学]