子宫内膜异位症术后转归的临床分析  

Clinical analysis of postoperative outcomes of endometriosis

作　　者：张梅莹[1] 狄文[1] 

机构地区：[1]上海交通大学医学院附属仁济医院,上海200127

出　　处：《中国妇幼健康研究》2013年第2期206-209,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的评估子宫内膜异位症患者手术后的转归情况。方法回顾上海交通大学医学院附属仁济医院2009至2010年来150例子宫内膜异位症患者的临床资料（年龄、生育史、术前治疗、手术情况、肿瘤标记物、内异症分期等），并随访手术后患者转归情况，进行临床评估和分析。结果子宫内膜异位症复发组的痛经发生率（76．9％）与对照组（23．1％）比较有统计学意义（P=0．025）。流产次数和内异症的分期有统计学意义（P=0．014），流产次数22次的重型内异症发生率高。术中的出血量与内异症的不同分期有统计学意义（P=0．023），重型开腹手术（135．7mL）与腹腔镜下手术（82．9mL）术中出血比较有统计学意义（P=0．012）。复发组的盆腔内异症灶与对照组比较有统计学意义（P=0．0088），复发组的盆腔粘连（86．5％）与否与对照组比较也具有统计学意义（P=0．0063）。术后GnRH治疗3周期的复发率（57．9％）与GnRH治疗6周期（17．0％）比较有统计学意义（P〈0．001）。结论子宫内膜异位症的高复发率同内异症合并肌瘤及肌腺症、盆腔内异病灶较多、盆腔广泛粘连、促性腺激素释放激素治疗周期短相关；腹腔镜是治疗内异症的首选，具有创伤小、出血少，安全性高的优点且治疗效果与开腹手术一致；重型内异症患者术后促性腺激素释放激素治疗可提高妊娠率。Objective To evaluate the postoperative outcomes of endometriosis. Methods The clinical data （age, delivery history, therapy before operation, operation condition, tumor markers, staging and so on） of 150 patients with endometriosis treated in Renji Hospital in 2009 and 2010 were retrospectively analyzed, and the patients were followed up for their prognosis. Results There was statistical significance in incidence of dysmenorrheal between recurrent group （76.9%） and control group （23.1%） （P =0. 025 ）. The differences in frequency of abortion and stage of endometriosis were significant （P = 0. 014）, and the incidence of severe endometriosis was high when frequency of abortion〉2. There were significant differences in intraoperative blood loss and stage of endometriosis （P =0.023 ） , and the intraoperative blood loss of open surgery （135.7mL） and laparoscopic surgery （82.9mL） was significantly different （P = 0. 012）. There were statistically significant differences between recurrent group and control group in pelvic lesions （ P = 0. 0088） and pelvic adhesion （P = 0. 0063）. The incidence of pelvic adhesion in recurrent group was 86.5%. The difference in recurrent rate between patients with GnRH therapy of 3 courses （57.9%） and those with GnRH therapy of 6 courses （ 17.0% ） was significant （P 〈 0. 001 ）. Conclusion The high recurrence rate of endometriosis is related with complications with myoma and adenomyosis, more lesions, severe adhesion and short treatment cycle of GnRH. Laparoscopic treatment is the first therapy for endometriosis with advantages of minor injury, less bleeding, high safety and same therapeutic effect as open surgery. GnRH therapy after surgery can enhance the pregnancy rate of patients with severe endometriosis.

关 键 词：子宫内膜异位症 腹腔镜手术 促进腺激素释放激素 辅助生育技术 

分 类 号：R711.71[医药卫生—妇产科学]