腹腔镜下子宫中心体切除术联合促性腺激素释放激素激动剂在子宫腺肌病治疗中的应用  

Application of central uterine body ectomy combined with gonadotrophin releasing hormone agonist under laparoscope on the treatment of adenomyosis

作　　者：卢玉娟[1] 王愚[1] 杨志玲 Lu Yujuan;Wang Yu;Yang Zhiling(Department of Obstetrics and Gynecology,The Affiliated Hospital of Chengdu University)

机构地区：[1]成都大学附属医院妇产科,成都610036

出　　处：《重庆医科大学学报》2020年第10期1478-1483,共6页Journal of Chongqing Medical University

基　　金：四川省卫计委科研课题资助项目(编号:150003)。

摘　　要：目的:探讨腹腔镜下子宫中心体切除术联合促性腺激素释放激素激动剂(gonadotrophin-releasing hormone agonist,GnRH-a)治疗子宫腺肌病的临床疗效。方法:选取2015年1月至2017年12月在成都大学附属医院因子宫腺肌病选择腹腔镜下子宫中心体切除术的35例患者作为研究组,随机选取同期行腹腔镜下全子宫切除术的子宫腺肌病患者35例作为对照组,其中行腹腔镜下子宫中心体切除术患者,术后给予促性腺激素释放激素激动剂(gonadotrophin-releasing hormone agonist,GnRHa)即诺雷得治疗6个月。2组患者术后均随访6~12个月,比较手术时间、术中出血、术后胃肠功能恢复时间、痛经改善情况、术后性生活质量、围绝经期症状及性激素水平及患者满意度。结果:研究组手术时间比对照组长,术中出血量比对照组多,差异有统计学意义(P=0.000),2组术后胃肠道功能恢复时间比较,差异无统计学意义(P=0.874);2组术后痛经较术前均明显减轻,差异有统计学意义(P=0.000);研究组术后月经量较术前明显减少(P=0.000),术后子宫大小较术前缩小,差异有统计学意义(P=0.035);研究组术后性生活质量高于对照组,差异有统计学意义(P=0.000);研究组术前和术后1年的雌激素(estradiol,E2)、卵泡刺激素(follicle-stimulating hormone,FSH)比较,差异无统计学意义(P=0.076,P=0.253);而对照组术后E2水平低于术前,术后FSH水平高于术前,差异有统计学意义(P=0.000),术后满意度调查,研究组明显高于对照组,差异有统计学意义(P=0.002)。结论:腹腔镜下子宫中心体切除术联合诺雷得治疗子宫腺肌病,改善了临床症状,满足了患者保留子宫的意愿,避免了子宫全切术造成的不良影响,术后患者恢复好及满意度较高,是要求保留子宫的子宫腺疾病患者值得选择的方法。Objective:To investigate the clinical curative effect of central uterine body ectomy combined with gonadotropin releasing hormone agonist(GnRH-a)under laparoscope on the treatment of adenomyosis. Methods:From January 2015 to December 2017,35 patients with adenomyosis who chose central uterine body ectomy under laparoscope in our hospital were selected as the study group and were treated with GnRH-a(zoladex)for 6 months after operation,and 35 patients with adenomyosis chose to laparoscopic hysterectomy were taken as the control group. Patients in the two groups were followed up for 6-12 months;the operation time,intraoperative blood loss,the recovery time of gastrointestinal function after operation,dysmenorrhea improvement,the quality of sexual life after operation,perimenopausal symptoms as well as relative sexual hormone levels and postoperative satisfaction degree were compared between two groups. Results:The operation time in the study group was longer than that in the control group,the intraoperative blood loss was more than that in the control group,with statistically significant difference(P=0.000). There was no significant difference in the recovery time of gastrointestinal function be-tween two groups(P=0.874). The dysmenorrhea in two groups after operation were significantly less than that before operation,with statistically significant difference(P=0.000). The quality of sexual life in the study group was higher than that in the control group(P =0.000). Level of estradiol(E2) and follicle-stimulating hormone(FSH)before operation and one year after operation in the study group had no significant difference(P=0.076,P=0.253). In the control group,the level of E2 one year after operation was lower than that before operation,and the level of FSH was higher than that before operation(P=0.002). The postoperative satisfaction in the study group was significantly higher than that in the control group(P=0.000). Conclusion:Central uterine body ectomy combined with zoladex under laparoscope on the treatment of ade

关 键 词：腹腔镜手术 子宫中心体切除术 子宫腺肌病 诺雷得 

分 类 号：R711.71[医药卫生—妇产科学]