卵巢子宫内膜异位囊肿合并深部浸润型子宫内膜异位症患者的临床特征和远期预后  

Clinical features and long-term prognosis of ovarian endometrioma with deep infiltrating endometriosis patients

作　　者：宋秀玲 陈静 Song Xiuling;Chen Jing(Department of Gynaecology and Obstetrics,PLA General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]解放军北部战区总医院妇产科,沈阳110016

出　　处：《中国综合临床》2023年第5期358-362,共5页Clinical Medicine of China

摘　　要：目的探讨卵巢子宫内膜异位囊肿(ovarian endometrioma,OMA)合并深部浸润型子宫内膜异位症(deep infiltrating endometriosis,DIE)患者的临床特征和远期预后。方法回顾性分析北部战区总医院2014年1月至2017年1月收治178例OMA患者的临床资料。患者均接受腹腔镜下卵巢囊肿剔除术,术后病理为OMA 83例(对照组),OMA合并DIE 95例(观察组)。收集患者的一般临床资料,包括年龄、孕产次、体质量指数、痛经时间和程度、糖类抗原125(carbohydrate 125,CA125)水平、不孕类型,以及其他疼痛症状。收集患者的手术相关指标,包括手术时间、术中出血量、囊肿直径及位置、是否合并子宫腺肌病、严重盆腔粘连,以及美国生育学会修订子宫内膜异位症分期标准(revised American Fertility Society,r-AFS)评分和分期。收集患者的术后随访指标,包括术后用药、用药方案、用药时间、妊娠结局以及复发情况、复发类型(疼痛复发、囊肿复发)。计量资料以x¯±s表示,组间比较采用独立样本t检验;计数资料以例(%)表示,组间比较采用χ^(2)检验。结果观察组患者年龄、疼痛视觉模拟量表评分,以及中、重度痛经和慢性盆腔痛、CA125升高比例均高于对照组[(33.8±5.5)岁比(32.0±5.2)岁,(5.4±1.2)分比(4.3±0.9)分,72.6%(69/95)比55.4%(46/83),24.2%(23/95)比8.4%(7/83),80.0%(76/95)比65.1%(54/83)],组间比较差异均有统计意义(t=2.23、P=0.031,t=6.83、P<0.001,χ^(2)=5.74、P=0.017,χ^(2)=7.87、P=0.005,χ^(2)=5.02、P=0.025)。观察组手术时间长于对照组[(75.1±20.1)min比(56.0±18.9)min],术中出血量多于对照组[(79.2±23.0)mL比(57.8±16.3)mL],双侧囊肿、严重盆腔粘连、合并子宫腺肌病和r-AFS分期为Ⅳ期比例以及r-AFS评分均高于对照组[54.7%(52/95)比34.9%(29/83),90.5%(86/95)比53.0%(44/83),41.1%(39/95)比22.9%(19/83),71.6%(68/95)比43.4%(36/83),(61.8±22.1)分比(39.4±19.1)分],组间比较差异均有统计意义(t=6.50、P<0.001,t=7.Objective To analyze the clinical features and long-term prognosis of ovarian endometrioma(OMA)with deep infiltrating endometriosis(DIE).Methods A retrospective analysis was conducted on the clinical data of 178 OMA patients admitted to the Northern Theater General Hospital from January 2014 to January 2017.All patients received laparoscopic ovarian cyst removal.There were 83 patients with OMA(control group)and 95 patients with OMA combined with DIE(observation group)diagnosed by postoperative pathology.The general clinical data of patients were collected,including age,number of pregnancies,body mass index(BMI),duration and severity of dysmenorrhea,levels of carbohydrate antigen 125(CA125),type of infertility,and other pain symptoms.The surgical related indicators of patients were collected,including the operation time,intraoperative bleeding,cyst diameter and location,whether combined with adenomyosis,severe pelvic adhesion,and the grading and staging of the American Fertility Society's revised staging standard for Endometriosis(rAFS).The postoperative follow-up indicators of patients were collected,including postoperative medication,medication regimen,medication time,pregnancy outcome,recurrence status,and type of recurrence(pain recurrence,cyst recurrence).The measurement data was represented by x¯±s,and independent sample t-test was used for inter group comparison.The counting data was represented by example(%),andχ^(2)test was used for inter group comparison.Results The age,VAS score,moderate and severe dysmenorrhea,chronic pelvic pain,and CA125 elevation in the observation group were higher than those in the control group[(33.8±5.5)years vs(32.0±5.2)years,(5.4±1.2)points vs(4.3±0.9)points,72.6%(69/95)vs 55.4%(46/83),24.2%(23/95)vs 8.4%(7/83),80.0%(76/95)vs 65.1%(54/83)],the differences between the two groups were statistically significant(t=2.23、P=0.031,t=6.83、P<0.001,χ^(2)=5.74、P=0.017,χ^(2)=7.87、P=0.005,χ^(2)=5.02、P=0.025).The operation time in the observation group was longer than tha

关 键 词：卵巢子宫内膜异位囊肿 深部浸润型子宫内膜异位症 腹腔镜下卵巢囊肿剔除术 预后 

分 类 号：R737.33[医药卫生—肿瘤] R711.71[医药卫生—临床医学]