盆丛神经子宫支阻断等联合手术治疗子宫腺肌病的疗效  

Evaluation of long-term curative effect of uterine branch of pelvic plexus block in combined laparoscopic surgical techniques for patients with adenomyosis

作　　者：刘茗敏[1] 瞿晓燕 杨伟红 江彩霞 李彩霞 程忠平 LIU Mingmin;QU Xiaoyan;YANG Weihong;JIANG Caixia;LI Caixia;CHENG Zhongping(Department of Gynecology and Obstetrics,The Affiliated Yangpu Hospital of Tongji Medical University,Shanghai 200090,China;Deparlment of Gynecology and Obstetrics,The Affiliated Tenth Hospital of Tongji Medical University,Shanghai 200072,China)

机构地区：[1]同济医科大学附属杨浦医院妇产科,上海200090 [2]同济医科大学附属第十人民医院妇产科,上海200072

出　　处：《中国妇幼健康研究》2020年第2期252-257,共6页Chinese Journal of Woman and Child Health Research

基　　金：上海市科委资助项目(16411971900).

摘　　要：目的探讨腹腔镜下盆丛神经子宫支阻断等联合手术缓解子宫腺肌病症状的长期疗效。方法2009年1月至2015年12月期间,上海同济大学附属杨浦医院妇产科将符合条件的168例子宫腺肌病患者随机分为两组,研究组最终入组74人,行腹腔镜下盆丛神经子宫支阻断+子宫动脉阻断+子宫腺肌病病灶部分切除术;对照组最终入组78人,行腹腔镜下子宫动脉阻断+子宫腺肌病病灶部分切除术。评估两组患者围手术期质量及术后12、24和36个月的临床疗效。结果随访36个月,研究组痛经评分由术前的(7.21±1.88)分下降至(3.32±1.48)分,对照组痛经评分由术前的(7.06±1.85)分下降至(4.50±2.15)分,两组痛经评分与术前比较均下降了,差异均有统计学意义(t值分别为17.26、7.67,均P<0.01);研究组术后12、24、36个月的痛经评分均低于对照组(t值分别为3.46、4.14、3.94,均P<0.01)。研究组中痛经复发1例(1.3%),对照组复发11例(14.1%)。术后36个月,两组月经量较术前减少,子宫体积较术前缩小(月经量:t值分别为11.01、14.20;子宫体积:t值均为9.70,均P<0.01),但两组间比较差异均无统计学意义(均P>0.05)。两组便秘/残余尿情况手术前后和组间比较差异均无统计学意义(均P>0.05)。结论腹腔镜下盆丛神经子宫支阻断等联合术式不仅为患者保留了子宫,更有效地缓解了子宫腺肌病痛经症状,值得临床推广。Objective To assess long-term curative effect of combined laparoscopic surgery with uterine branch of pelvic plexus block(UBPPB)for relief of dysmenorrhea symptom of patients with adenomyosis.Methods The clinical data of 168 women with adenomyosis treated in Department of Gynecology and Obstetrics,The Affiliated Yangpu Hospital of Tongji Medical University from January 2009 to December 2015 were reviewed.74 patients who underwent laparoscopic uterine branch of pelvic plexus block(LUBPPB)plus uterine artery occlusion(UAO)and plus partial adenomyomectomy(PA)were divided into study group and 78 patients who underwent LPA plus UAO were divided into control group.The perioperative quality of life and clinical curative effect at 12 months,24 months and 36 months after operation of the patients in the two groups were evaluated.Dysmenorrhea was evaluated using a 10-cm visual analog scale(VAS).Rectal dysfunction was assessed by using Wexner’s scoring system and bladder dysfunction was based on the patient’s complaint and residual urine volume was measured by Color Doppler.Menstrual blood loss was measured using apictorial blood loss assessment chart.Uterine volume was calculated using prolate ellipse equation by vaginal ultrasonography.Results At follow-up of 36 months after operation,the dysmenorrhea score of the patients in the study group was decreased from 7.21±1.88 before operation to 363.32±1.48 after operation,and that in the control group was decreased from 7.06±1.85 before operation to 4.50±2.15 after operation.As compared with that before operation,the dysmenorrhea scores of the patients in both groups were improved and there were significant differences(t=17.26,7.67 respectively,both P<0.01).And the dysmenorrhea scores of the patients in the study group at 12 months,24 months and 36 months after operation were better than those in the control group(t=3.46,4.14 and 3.94 respectively,all P<0.01).1 case(1.3%)of dysmenorrhea in the study group and 11 cases(14.1%)of dysmenorrhea in the control group relapsed

关 键 词：子宫腺肌病 痛经 盆丛神经 子宫支阻断 子宫动脉 

分 类 号：R714.244[医药卫生—妇产科学]