腹腔镜保守手术治疗子宫腺肌瘤疗效观察.docVIP

腹腔镜保守手术治疗子宫腺肌瘤疗效观察吕 嬿，冷金花，戴毅，史精华，郎景和 　　摘要:目的 探讨子宫腺肌瘤腹腔镜保守手术的临床特点和治疗效果。方法以 2004 年 4 月到 2007 年 7 月于北京协和医院行腹腔镜子宫腺肌瘤病灶挖除术的 72 例患者为研究对象，记录其临床特点、辅助治疗、随访结果和妊娠结局，回顾性分析复发和妊娠的相关因素。结果 ( 1) 腹腔镜子宫腺肌瘤病灶挖除术后 2 年，患者痛经程度减轻，子宫体积缩小，血清 CA125 值下降，和术前相比差异有统计学意义( P 0. 05) 。( 2) 术后症状复发率34. 7% ，复发中位时间 30 个月。复发组患者的年龄和子宫体积更大，术后妊娠者的复发率低于未妊娠者( P 0. 05) 。( 3) 和单纯手术组相比，术后辅助促性腺激素释放激素激动剂( GnRHa) 组患者的子宫体积更大、多发腺肌瘤及合并子宫内膜异位症的比例更高( P 0. 05) ，但两组复发率差异无统计学意义。( 4) 术后妊娠率 68. 8%，分娩率 46. 9%。妊娠距离手术的中位时间为 13 个月。未发现影响妊娠的有统计学意义的临床因素。结论对于有生育要求的局限性腺肌瘤患者，腹腔镜子宫腺肌瘤病灶挖除术能有效缓解症状、促进妊娠。年轻、子宫体积大的患者更容易复发，术后妊娠对复发有保护作用。术后联合 GnRHa 治疗有助于减少复发，但对妊娠的益处尚不肯定。 　　关键词:子宫腺肌瘤; 腹腔镜; 促性腺激素释放激素; 复发; 妊娠 　　The medium to long term clinical outcomes of laparoscopic conservative surgery on adenomyomas. L，LENG Jin-hua，DAI Yi，SHI Jing-hua，LANG Jing-he. Department of Obstetrics and Gynecology，Peking Union Med-ical College Hospital，Peking Union Medical College，Chinese Academy of Medical Science，Beijing 100730，ChinaAbstract: Objective To investigate the clinical characteristics and treatment effects of laparoscopic conservative surgeryon adenomyomas. Method A total of 72 patients undergoing laparoscopic resection of adenomyoma in Peking Union Me-dial College Hospital between April 2004 and July 2007 were studied retrospectively. The data of clinical manifestation，adjuvant therapy，follow-up results and pregnancy outcomes were assessed. The association factors of recurrence andpregnancy were analyzed. Result ( 1) Two years after surgery，patients had statistically significant relief of dysmenor-rhea，shrinkage of uterine volume and decline of serum CA125 level ( P 0. 05) . ( 2) The symptom relapse rate was34. 7% . Median interval between surgery and relapse was 30 months. The relapsed patients were featured with statistical-ly significantly younger age，larger uterine volume and lower pregnancy rates following surgery ( P 0. 05) . ( 3) Thoughthe surgical followed by GnRHa group had statistically significant larger uterine volume，higher rates of multi