子宫腺肌病患者应用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗效果观察
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摘要
目的:观察对子宫腺肌病采用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗方法的临床效果。方法:将63例子宫腺肌病患者根据治疗方法分为两组,研究组(n=33)采用腹腔镜子宫楔形切除术合并术后阴道置放左炔诺孕酮宫内缓释系统治疗,对照组(n=30)仅采用腹腔镜子宫楔形切除术治疗;观察比较两组患者术后3、6、12、24个月的子宫体积、月经量、痛经评分、血红蛋白、血清CA125水平及术后随访期间的复发和妊娠情况。结果:研究组患者术后12个月及24个月时的子宫体积小于对照组(P<0.05),术后12月及24月时的疼痛评分显著低于对照组(P<0.01),术后24个月时的月经量少于对照组(P<0.01);研究组患者术后24月内的血清CA125及血红蛋白水平控制较好,而对照组术后血清CA125水平逐渐升高,而血红蛋白水平逐渐降低,但两组数据间比较差异无统计学意义(P>0.05);研究组中术后24个月内0例复发,而对照组出现3例复发(P>0.05);对照组2例患者顺利妊娠,研究组中无患者成功妊娠。结论:采用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗子宫腺肌病可更有效地缓解患者的症状,控制疾病的进展,故具有较好的疗效。
Objective: To observe the effect of postoperative use of levonorgestrel slow releasing system in the vagina on adenomyosis patients after laparoscopic uterus wedge resection. Methods: 63 patients with uterine adenomyosis were divided into two groups according to different treatment. The research group( n = 33) was given the laparoscopic uterus wedge resection combined with postoperative use of levonorgestrel slow releasing system in the vagina,while the control group( n = 30) was only given laparoscopic wedge resection of the uterus. The uterine volume,menstrual quantity,dysmenorrhea scores,hemoglobin,serum CA125 level of two groups at postoperative 3,6,12,24 months and postoperative recurrence and pregnancy rate were compared. Results: The uterine volume of the research group at 12 months and 24 months postoperatively was less than that of the control group( P < 0. 05).The pain score of the research group at 12 months and 24 months postoperatively was significantly less than that of control group( P < 0. 01). The menstrual quantity of the research group at 24 months was obviously less than that of the control group( P < 0. 01). The serum CA125 and hemoglobin level of the research group after operation were stable,while the serum CA125 level of the control group increased and the hemoglobin gradually decreased,without statistically significant difference( P > 0. 05). The recurrence of the research group and control group after operation was 0 and 3 cases respectively( P > 0. 05). The control group had 2 cases of successful pregnancy,and the research group had none. Conclusions: The postoperative use of levonorgestrel slow releasing system in the vagina on adenomyosis patients with laparoscopic uterus wedge resection can more effectively relieve symptoms,control the progress of the disease,hereby exerting a better clinical effect.
Objective: To observe the effect of postoperative use of levonorgestrel slow releasing system in the vagina on adenomyosis patients after laparoscopic uterus wedge resection. Methods: 63 patients with uterine adenomyosis were divided into two groups according to different treatment. The research group( n = 33) was given the laparoscopic uterus wedge resection combined with postoperative use of levonorgestrel slow releasing system in the vagina,while the control group( n = 30) was only given laparoscopic wedge resection of the uterus. The uterine volume,menstrual quantity,dysmenorrhea scores,hemoglobin,serum CA125 level of two groups at postoperative 3,6,12,24 months and postoperative recurrence and pregnancy rate were compared. Results: The uterine volume of the research group at 12 months and 24 months postoperatively was less than that of the control group( P < 0. 05).The pain score of the research group at 12 months and 24 months postoperatively was significantly less than that of control group( P < 0. 01). The menstrual quantity of the research group at 24 months was obviously less than that of the control group( P < 0. 01). The serum CA125 and hemoglobin level of the research group after operation were stable,while the serum CA125 level of the control group increased and the hemoglobin gradually decreased,without statistically significant difference( P > 0. 05). The recurrence of the research group and control group after operation was 0 and 3 cases respectively( P > 0. 05). The control group had 2 cases of successful pregnancy,and the research group had none. Conclusions: The postoperative use of levonorgestrel slow releasing system in the vagina on adenomyosis patients with laparoscopic uterus wedge resection can more effectively relieve symptoms,control the progress of the disease,hereby exerting a better clinical effect.
引文
[1]王岩岩,黄立,王艳华,等.腹腔镜下病灶切除术联合醋酸亮丙瑞林缓释微球治疗子宫腺肌病临床分析.中国综合临床,2016,32(4):375-378.
[2]Beretta P.Surgical treatment of symptomatic endometriosis.Fertil Steril,2010,53(3):411-416.
[3]杨淑英,向群,陈雪兰,等.腹腔镜子宫肌瘤切除手术难度评分系统在腹腔镜子宫肌瘤切除手术中应用评估.中国性科学,2015,24(1):24-26.
[4]李锦行,刘红,张萍.腹腔镜下子宫腺肌病病灶切除术联合促性腺激素释放激素激动剂治疗子宫腺肌病的疗效观察.现代妇产科进展,2015,24(10):743-746.
[5]石永云,许传奎,吕发辉,等.腹腔镜下病灶切除术联合米非司酮治疗子宫腺肌瘤的临床分析.中国医学前沿杂志(电子版),2015,7(7):53-55.
[6]王文霞,林利红.腹腔镜下子宫体楔形切除术实施的可行性及安全性分析.中国性科学,2015,24(5):21-23.
[7]李晓欣,张萍,张纯溪.促性腺激素释放激素激动剂联合腹腔镜手术治疗大子宫腺肌病疗效的研究.中国计划生育和妇产科,2016(7):63-67.
[8]熊薇,王飞飞,罗利,等.腹腔镜下子宫腺肌瘤局灶切除术联合GnRH-a治疗的效果研究.实用妇产科杂志,2016,32(12):930-932.
[9]张强.子宫腺肌症患者应用腹腔镜下病灶切除术的近期疗效及预后分析.实用临床医药杂志,2016,20(1):168-169.
[10]顾志群.宫腔镜下子宫内膜息肉切除术后口服雌孕激素与曼月乐环疗效对比分析.检验医学,2016(B9):154-155.
[11]吴泉,周萍.口服孕三烯酮、子宫全切、放置曼月乐对子宫腺肌病患者性功能和婚姻质量的影响研究.中国妇幼保健,2015,30(28):4790-4792.
[12]Huang TS,Chen YJ,Chou TY,et al.Oestrogen-induced angiogenesis promotes adenomyosis by activating the Slug-VEGF axis in endometrial epithelial cell.J Cell Mol Med,2014,18(7):1358-1371.
[13]赵蓉,顾玉婵,王丽梅,等.腹腔镜子宫楔形切除术并术后阴道置放曼月乐治疗子宫腺肌病效果观察.山东医药,2016(7):52-54.
[14]Carrarelli P,Yen CF,Arcuri F,et al.Myostatin,follistatin and activin type II receptors are highly expressed in adenomyosis.Fertil Steril,2015,104(3):744-752.
[15]张彭南,朱杰,薛晓红.腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床分析.现代妇产科进展,2015(2):135-137.
[16]李亚军,李文影,秦文芝.腹腔镜子宫腺肌症病灶切除术联合促性腺激素释放激素激动剂治疗子宫腺肌症临床效果分析.中国医药,2014,9(10):1542-1546.
[17]楚蔚昕,葛伟平,张萍.腹腔镜子宫腺肌病病灶切除联合GnRH-a治疗的对比研究.中国微创外科杂志,2015,10(10):897-900.
[18]高子轩,栾峰,颜友良.子宫缩减成形术合并促性腺激素释放激素激动剂治疗弥漫型子宫腺肌病的研究.中国现代手术学杂志,2015,9(2):141-144.
[2]Beretta P.Surgical treatment of symptomatic endometriosis.Fertil Steril,2010,53(3):411-416.
[3]杨淑英,向群,陈雪兰,等.腹腔镜子宫肌瘤切除手术难度评分系统在腹腔镜子宫肌瘤切除手术中应用评估.中国性科学,2015,24(1):24-26.
[4]李锦行,刘红,张萍.腹腔镜下子宫腺肌病病灶切除术联合促性腺激素释放激素激动剂治疗子宫腺肌病的疗效观察.现代妇产科进展,2015,24(10):743-746.
[5]石永云,许传奎,吕发辉,等.腹腔镜下病灶切除术联合米非司酮治疗子宫腺肌瘤的临床分析.中国医学前沿杂志(电子版),2015,7(7):53-55.
[6]王文霞,林利红.腹腔镜下子宫体楔形切除术实施的可行性及安全性分析.中国性科学,2015,24(5):21-23.
[7]李晓欣,张萍,张纯溪.促性腺激素释放激素激动剂联合腹腔镜手术治疗大子宫腺肌病疗效的研究.中国计划生育和妇产科,2016(7):63-67.
[8]熊薇,王飞飞,罗利,等.腹腔镜下子宫腺肌瘤局灶切除术联合GnRH-a治疗的效果研究.实用妇产科杂志,2016,32(12):930-932.
[9]张强.子宫腺肌症患者应用腹腔镜下病灶切除术的近期疗效及预后分析.实用临床医药杂志,2016,20(1):168-169.
[10]顾志群.宫腔镜下子宫内膜息肉切除术后口服雌孕激素与曼月乐环疗效对比分析.检验医学,2016(B9):154-155.
[11]吴泉,周萍.口服孕三烯酮、子宫全切、放置曼月乐对子宫腺肌病患者性功能和婚姻质量的影响研究.中国妇幼保健,2015,30(28):4790-4792.
[12]Huang TS,Chen YJ,Chou TY,et al.Oestrogen-induced angiogenesis promotes adenomyosis by activating the Slug-VEGF axis in endometrial epithelial cell.J Cell Mol Med,2014,18(7):1358-1371.
[13]赵蓉,顾玉婵,王丽梅,等.腹腔镜子宫楔形切除术并术后阴道置放曼月乐治疗子宫腺肌病效果观察.山东医药,2016(7):52-54.
[14]Carrarelli P,Yen CF,Arcuri F,et al.Myostatin,follistatin and activin type II receptors are highly expressed in adenomyosis.Fertil Steril,2015,104(3):744-752.
[15]张彭南,朱杰,薛晓红.腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床分析.现代妇产科进展,2015(2):135-137.
[16]李亚军,李文影,秦文芝.腹腔镜子宫腺肌症病灶切除术联合促性腺激素释放激素激动剂治疗子宫腺肌症临床效果分析.中国医药,2014,9(10):1542-1546.
[17]楚蔚昕,葛伟平,张萍.腹腔镜子宫腺肌病病灶切除联合GnRH-a治疗的对比研究.中国微创外科杂志,2015,10(10):897-900.
[18]高子轩,栾峰,颜友良.子宫缩减成形术合并促性腺激素释放激素激动剂治疗弥漫型子宫腺肌病的研究.中国现代手术学杂志,2015,9(2):141-144.