腹腔镜手术治疗卵巢巧克力囊肿４９例临床分析.DOCVIP

临床医学论文-腹腔镜手术治疗卵巢巧克力囊肿４９例临床分析 ??????? 作者：李国华，王强庆，王秀芬，尹克春 【摘要】? 目的：探讨腹腔镜手术治疗卵巢巧克力囊肿的临床应用价值。方法：回顾分析200１年１０月至200７年１０月经腹腔镜手术治疗巧克力囊肿４９例患者的临床资料。结果：４８例在腹腔镜下成功完成手术，其中一侧囊肿剥除术２８例，双侧囊肿剥除术１８例，一侧附件切除术２例，同时行输卵管造口术２例；１例因出血中转开腹。均无术后并发症发生。术后４６例服用孕三烯酮２～６个月。３例肝功异常的患者皮下注射GHRHa 3～6个月。术后随访患者均对疗效满意。结论：腹腔镜手术可作为治疗卵巢巧克力囊肿的首选术式。术中应避免输尿管、髂血管、低位肠管等部位的损伤，注意保留卵巢功能，避免卵巢早衰，术后联合用药，复发率低。 【关键词】? 卵巢巧克力囊肿；腹腔镜术；病例报告 ??? 【Abstract】? Objective:To explore the clinical value of laparoscopic operation to treat ovary chocolate cysts.Methods:The clinical data of 49 cases of ovary chocolate cysts treated by laparoscopy from Oct.2001 to Oct.2007 retrospectively analyzed.Results:Fortyeight cases were performed by laparoscopy,among them 28 cases underwent unilateral cysts resection,18 cases underwent bilateral cysts resection and 2 cases urderwent unilateral adnexa resection.Salpingostomy were performed in 2 cases and 1 case converted to laparotomy for bleeding.There were no postoperative complications.All cases had been followed up.46 cases were given gestrinone ovally for 2 to 6 months because of abnormal hepatic function.3 cases were given GnRHa for 3 to 6 months.The results were satisfactory.Conclusions:Laparoscopic operation is the first choice for ovary choclate cyst.The injurys of ureter,iliac vessels,low enteron should be avoided.Ovary function should be reserved in order to prevent premature ovary failure.The application comkined with durgs after surgery can decreare the recurrence rate. ??? 【Key words】? Endometrialcyst of ovary;Laparoscopy;Case report ??? 子宫内膜异位症是育龄妇女的常见病，发病率可高达１０％～１５％［１］。卵巢巧克力囊肿是最常见的子宫内膜异位症类型。随着腹腔镜技术的推广，以明确诊断、减灭病灶、分离粘连、减轻症状和促进生育为目的的保守性腹腔镜手术已成为处理巧克力囊肿的首选术式。由于子宫内膜异位症病变广泛，粘连严重，病灶周围血管丰富等特点，使得子宫内膜异位症手术难度加大，并发症的几率增多。２００１年１０月至２００７年１０月我院经腹腔镜手术治疗巧克力囊肿患者４９例，现将体会报道如下。 ??? 1? 资料与方法 ??? 1.1? 临床资料? ４９例患者１8～4６岁，平均２９.６岁。病变部位左侧１８例，右侧１１例，双侧２０例；未婚５例，不孕４例。 ??? １.２? 临床表现? 痛经２８例，月经紊乱４例，不孕４例，自扪到下腹包块２例，下腹痛伴性交痛２例，体检发现附件包块９例。妇科检查示子宫一侧或双侧可扪及直径４～１２cm质中等的包块，与子宫关系欠清。２２例可扪及子宫后壁触痛结节。超声检查提示肿块囊性４０例，混合性６例，实性占位３例。血清ＣＡ１２