腹腔镜子宫内膜异位症手术效果分析
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摘要
目的探讨子宫内膜异位症的腹腔镜手术治疗评估分析腹腔镜手术对子宫内膜异位症的治疗效果。方法回顾性分析2015年1月—2018年6月期间在合肥市第二人民医院行腹腔镜手术治疗的子宫内膜异位症患者共81例为观察组,选取同期在合肥市第二人民医院行开腹手术治疗的子宫内膜异位症患者40例为对照组,比较2组在手术时间、术中出血量、术后住院天数、不良反应发生率、术后疼痛情况等方面的差异,2组患者术后均使用亮丙瑞林微球针皮下注射治疗4～6个月,术后随访36个月,比较2组子宫内膜异位症的复发率,同时比较2组40岁以下妇女妊娠率。结果观察组手术时间[(56.23±8.59)min]、术中出血量[(65.42±6.54)mL]、住院天数[(5.23±1.24)d]与对照组[(100.45±10.03)min、(105.63±8.26)mL、(7.24±2.56)d]相比,差异有统计学意义(均P<0.05)。随访36个月后,观察组复发率为3.70%(3/81),明显低于对照组的25.00%(10/40),观察组40岁以下妊娠率为56.52%(35/62),明显高于对照组的15.00%(3/20,P<0.05)。结论在子宫内膜异位症的手术治疗中,腹腔镜手术治疗具有操作时间短、出血量少、住院天数少、不良反应发生率低、复发率小、妊娠率高等优点,可以考虑作为子宫内膜异位症手术治疗的首选方案。
Objective To investigate the treatment of endometriosis by laparoscopic surgery, and to evaluate and analyze the therapeutic effect of laparoscopic surgery on endometriosis. Methods A total of 81 cases of endometriosis treated by laparoscopic surgery in our hospital from January 2015 to June 2018 were included as the observation group and 40 cases of endometriosis treated by open surgery in our hospital during the same period were the control group. Retrospective analysis was made to compare two groups in operative time, intraoperative blood loss, postoperative hospitalization days, incidence of adverse reactions, such as postoperative pain of differences. Patients in the two groups were treated with subcutaneous injection of leuprorelin acetate microspheres for 4-6 months after surgery, followed up for 36 months, and the recurrence rates of endometriosis in the two groups were compared, as well as the pregnancy rates of women under 40 years old in the two groups. Results The operative time(56.23±8.59) min, intraoperative blood loss(65.42±6.54) mL, and days of hospitalization(5.23±1.24) days in the observation group were significantly different from those in the control group(100.45±10.03) min,(105.63±8.26) mL, and(7.24±2.56) days(all P<0.05). After 36 months of follow-up, the recurrence rate of 3.70%(3/81) in the observation group was significantly lower than 25.00%(10/40) in the control group, and the pregnancy rate of 56.52%(35/62) in the observation group was significantly higher than 15.00%(3/20) in the control group(P<0.05). Conclusion In the surgical treatment of endometriosis, laparoscopic surgery has the advantages of short operation time, less blood loss, fewer days in hospital, low incidence of adverse reactions, low recurrence rate and high pregnancy rate, which can be considered as the preferred surgical treatment for endometriosis.
Objective To investigate the treatment of endometriosis by laparoscopic surgery, and to evaluate and analyze the therapeutic effect of laparoscopic surgery on endometriosis. Methods A total of 81 cases of endometriosis treated by laparoscopic surgery in our hospital from January 2015 to June 2018 were included as the observation group and 40 cases of endometriosis treated by open surgery in our hospital during the same period were the control group. Retrospective analysis was made to compare two groups in operative time, intraoperative blood loss, postoperative hospitalization days, incidence of adverse reactions, such as postoperative pain of differences. Patients in the two groups were treated with subcutaneous injection of leuprorelin acetate microspheres for 4-6 months after surgery, followed up for 36 months, and the recurrence rates of endometriosis in the two groups were compared, as well as the pregnancy rates of women under 40 years old in the two groups. Results The operative time(56.23±8.59) min, intraoperative blood loss(65.42±6.54) mL, and days of hospitalization(5.23±1.24) days in the observation group were significantly different from those in the control group(100.45±10.03) min,(105.63±8.26) mL, and(7.24±2.56) days(all P<0.05). After 36 months of follow-up, the recurrence rate of 3.70%(3/81) in the observation group was significantly lower than 25.00%(10/40) in the control group, and the pregnancy rate of 56.52%(35/62) in the observation group was significantly higher than 15.00%(3/20) in the control group(P<0.05). Conclusion In the surgical treatment of endometriosis, laparoscopic surgery has the advantages of short operation time, less blood loss, fewer days in hospital, low incidence of adverse reactions, low recurrence rate and high pregnancy rate, which can be considered as the preferred surgical treatment for endometriosis.
引文
[1] CHEN Y,ZHU H L,TANG Z W,et al.Evaluation of circulating endometrial cells as a biomarker for endometriosis[J].Chin Med J(Engl),2017,130(19):2339-2345.
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[6] 陈敏,王远菊,王彩霞.腹腔镜下卵巢子宫内膜异位囊肿剥离术前使用GnRH-a预处理对卵巢储备功能的影响[J].现代妇产科进展,2016,25(10):772-774.
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[8] 温方圆.腹腔镜下卵巢子宫内膜异位症囊肿剥除术前使用亮丙瑞林对卵巢储备功能的保护效果研究[J].中国妇幼保健,2016,31(8):1752-1754.
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[10] 陈雪兰,陈光元,黄平,等.腹腔镜卵巢子宫内膜异位囊肿剥除术联合亮丙瑞林对卵巢储备功能及生育的影响[J].海南医学,2016,27(16):2638-2640.
[11] 曾丹凌.腹腔镜下卵巢子宫内膜异位症囊肿剥除术前应用亮丙瑞林对卵巢储备功能的影响[J].福建医药杂志,2017,39(1):32-34.
[12] 杨扬,黄飞翔.腹腔镜下卵巢子宫内膜异位症囊肿剥除术前应用亮丙瑞林微球对卵巢储备功能的保护效果[J].中国生化药物杂志,2016,36(8):55-57.
[13] 骆婕.子宫内膜异位症治疗中腹腔镜手术的应用价值[J].中国实用医药,2018,13(18):63-64.
[14] 甄文明,邹岚,伍洁燕.腹腔镜手术治疗卵巢子宫内膜异位症的临床效果评估[J].中国医学创新,2018,15(3):111-113.
[15] 王敏,潘月,罗汝琼.GnRH-a联合腹腔镜手术治疗卵巢子宫内膜异位症的疗效及对卵巢储备功能的影响[J].中国妇幼保健,2018,33(8):1742-1744.
[16] 高志红.腹腔镜手术联合GnRH-a治疗卵巢子宫内膜异位囊肿患者的临床观察[J].广西医科大学学报,2016,33(1):137-139.
[17] 郎月华,楼彩虹,李云,等.腹腔镜下卵巢子宫内膜异位囊肿剔除术中3种止血方式对术后卵巢功能的影响[J].中华全科医学,2017,15(12):2089-2092.
[18] 梅芳,张敏,胡霞.腹腔镜卵巢子宫内膜异位症囊肿剥除术中三种不同止血方法对卵巢储备功能的影响[J].临床和实验医学杂志,2015,14(13):1120-1123.
[19] 彭锡安,罗曼漪.腹腔镜手术联合药物治疗卵巢子宫内膜异位症临床观察[J].中国医学创新,2015,12(7):117-120.
[20] 王倩倩,郭祥翠.GnRHa联合腹腔镜保守手术治疗子宫内膜异位症临床分析[J].肿瘤学杂志,2015,21(5):419-422.
[2] GUO H,WANG Y,CHEN Q,et al.Use of medroxyprogesterone acetate in women with ovarian endometriosis undergoing controlled ovarian hyperstimulation for in vitro fertilization [J].Sci Rep,2017,7(1):11927.
[3] KONDO W,RIBEIRO R,ZOMER M T,et al.Laparoscopic double discoid resection with a circular stapler for bowel endometriosis[J].J Minim Invasive Gynecol,2015,22(6):929-931.
[4] BAGGIO S,ZECCHIN A,POMINI P,et al.The role of computed tomography colonography in detecting bowel involvement in women with deep infiltrating endometriosis:comparison with clinical history,serum CA125,and transvaginal sonography[J].J Comput Assist Tomogr,2016,40(6):886-891.
[5] 刘军,王凤丽,李银凤.血清CA125、FS在卵巢子宫内膜异位症中的临床应用价值[J].疾病监测与控制杂志,2017,11(6):442-445.
[6] 陈敏,王远菊,王彩霞.腹腔镜下卵巢子宫内膜异位囊肿剥离术前使用GnRH-a预处理对卵巢储备功能的影响[J].现代妇产科进展,2016,25(10):772-774.
[7] SOLIMAN A M,BONAFEDE M,FARR A M,et al.Analysis of adherence,persistence,and surgery among endometriosis patients treated with leuprolide acetate plus norethindrone acetate add - back therapy[J].J Manag Care Spec Pharm,2016,22(5):573-587.
[8] 温方圆.腹腔镜下卵巢子宫内膜异位症囊肿剥除术前使用亮丙瑞林对卵巢储备功能的保护效果研究[J].中国妇幼保健,2016,31(8):1752-1754.
[9] 傅炜.腹腔镜卵巢子宫内膜异位囊肿剥除术联合亮丙瑞林对卵巢储备功能及生育的影响[J].现代诊断与治疗,2017,28(10):1891-1892.
[10] 陈雪兰,陈光元,黄平,等.腹腔镜卵巢子宫内膜异位囊肿剥除术联合亮丙瑞林对卵巢储备功能及生育的影响[J].海南医学,2016,27(16):2638-2640.
[11] 曾丹凌.腹腔镜下卵巢子宫内膜异位症囊肿剥除术前应用亮丙瑞林对卵巢储备功能的影响[J].福建医药杂志,2017,39(1):32-34.
[12] 杨扬,黄飞翔.腹腔镜下卵巢子宫内膜异位症囊肿剥除术前应用亮丙瑞林微球对卵巢储备功能的保护效果[J].中国生化药物杂志,2016,36(8):55-57.
[13] 骆婕.子宫内膜异位症治疗中腹腔镜手术的应用价值[J].中国实用医药,2018,13(18):63-64.
[14] 甄文明,邹岚,伍洁燕.腹腔镜手术治疗卵巢子宫内膜异位症的临床效果评估[J].中国医学创新,2018,15(3):111-113.
[15] 王敏,潘月,罗汝琼.GnRH-a联合腹腔镜手术治疗卵巢子宫内膜异位症的疗效及对卵巢储备功能的影响[J].中国妇幼保健,2018,33(8):1742-1744.
[16] 高志红.腹腔镜手术联合GnRH-a治疗卵巢子宫内膜异位囊肿患者的临床观察[J].广西医科大学学报,2016,33(1):137-139.
[17] 郎月华,楼彩虹,李云,等.腹腔镜下卵巢子宫内膜异位囊肿剔除术中3种止血方式对术后卵巢功能的影响[J].中华全科医学,2017,15(12):2089-2092.
[18] 梅芳,张敏,胡霞.腹腔镜卵巢子宫内膜异位症囊肿剥除术中三种不同止血方法对卵巢储备功能的影响[J].临床和实验医学杂志,2015,14(13):1120-1123.
[19] 彭锡安,罗曼漪.腹腔镜手术联合药物治疗卵巢子宫内膜异位症临床观察[J].中国医学创新,2015,12(7):117-120.
[20] 王倩倩,郭祥翠.GnRHa联合腹腔镜保守手术治疗子宫内膜异位症临床分析[J].肿瘤学杂志,2015,21(5):419-422.