腹腔镜保守性手术治疗子宫内膜异位症后复发相关因素分析及预防对策  

Analysis on the related factors of recurrence of endometriosis after laparoscopic conservative surgery and prevention countermeasures

作　　者：梁华[1] 洛若愚[1] 

机构地区：[1]武汉大学人民医院妇一科,湖北武汉430062

出　　处：《中国妇幼保健》2017年第10期2234-2237,共4页Maternal and Child Health Care of China

摘　　要：目的分析腹腔镜保守性手术治疗子宫内膜异位症(EMs)后复发相关因素,并提出预防对策。方法回顾性分析武汉大学人民医院2010年1月-2013年12月择期行腹腔镜保守性手术治疗的150例EMs患者相关资料,随访3年,根据复发与否将所有患者分为复发组与非复发组,对两组患者的年龄、临床分期等指标比较,应用单因素及多因素Logistic回归分析腹腔镜保守性手术治疗EMs后复发相关因素。结果腹腔镜保守性手术治疗EMs后3年复发43例,占28.67%;单因素分析显示:复发组患者术前痛经史、Ⅲ~Ⅳ期、宫腔操作史所占比例均明显高于未复发组,术后辅助用药率明显低于未复发组,差异有统计学意义(χ~2=9.517、6.541、6.933、11.993,P<0.05),复发组患者实际年龄、发病年龄明显小于未复发组,术前孕次、术前产次均明显大于未复发组,术后孕次小于未复发组,差异有统计学意义(t=3.715、6.377、2.316、2.164、7.665,P<0.05);多因素Logistic回归分析显示,术后复发独立危险因素包括术前痛经史、临床分期、既往宫腔操作史,保护因子包括术前孕次、术后孕次、术后辅助用药;150例患者中术后采取促性腺激素释放激素激动剂(GnRHa)治疗86例(GnRHa组),孕三烯酮治疗21例(孕三烯酮组),无辅助用药43例(手术组),用药组治疗效果优于手术组,3组比较差异有统计学意义(Z=26.956、26.230,P<0.05)。结论腹腔镜保守性手术治疗EMs后复发危险因素为术前痛经史、既往宫腔操作史等,而术前孕次、术后孕次、术后辅助用药为其保护性因素。为此减少宫腔操作,加强长期用药管理,积极助孕成功妊娠可作为预防术后复发的重要对策。Objective To analyze the related factors of recurrence of endometriosis after laparoscopic conservative surgery, and put forward prevention countermeasures. Methods The related data of 150 patients with endometriosis undergoing selective laparoscopic conservative surgery in the hospital from January 2010 to December 2013 was analyzed retrospectively. All the patients were followed up for three years, then they were divided into recurrence group and non-recurrence group. Age and clinical stages of patients in the two groups were compared. Univariate and multivariate logistic regression analysis were performed to analyze the related factors of recurrence of endometriosis after laparoscopic conservative surgery. Results After laparoscopic conservative surgery, endometriosis recurred in 43 patients, accounting for 28.67%. Univariate analysis showed that the proportions of patients with history of preoperative dysmenorrhea, clinical stage and previous history of uterine cavity operation in recurrence group were higher than those in non-recurrence group, while the rate of postoperative adjuvant drug therapy in recurrence group was lower than that in non-recurrence group, there were statistically significant differences （χ^2 = 9.517, 6. 541,6. 933, 11. 993, P〈0. 05 ） . The actual age and onset age of patients in recurrence group was less than that in non-re- currence group, preoperative parity and gravidity in recurrence group were more than those in non-recurrence group, postoperative gravidity in recurrence group was less than that in non-recurrence group, there were statistically significant differences （t = 3. 715, 6. 377, 2. 316, 2. 164, 7. 665, P〈0. 05 ） . Multivariate logistic regression analysis showed that the independent risk factors of postoperative recurrence included history of preoperative dysmenorrhea, clinical stages, previous history of uterine cavity operation; the protective factors included preoperative and postoperative gravidity, postoperative adjuvant drug therapy. All the patients we

关 键 词：子宫内膜异位症 腹腔镜保守性手术 复发 相关因素 预防对策 

分 类 号：R713[医药卫生—妇产科学]