腹腔镜手术联合“内异消散方”治疗子宫内膜异位症的临床观察
发布时间：2018-03-17 13:21
本文选题：腹腔镜手术 切入点：子宫内膜异位症 出处：《新乡医学院》2017年硕士论文 论文类型：学位论文
【摘要】：背景子宫内膜异位症(endometriosis,EMS)是指有活性的子宫内膜细胞种植在子宫内膜以外的位置而形成的一种妇科疾病。该病的发生依赖于雌激素,因而发病常见于育龄期妇女,其发病症状主要表现为不孕、月经异常、痛经和性交疼痛,易发生复发和转移。目前,手术治疗是治疗该病的首选方案,并已成为广泛应用的治疗方案。因该病保守手术术后易复发特点,为使残留体内的一些微小致病因子受到抑制、进而萎缩甚至退化,达到延缓复发和治愈的目的,术后结合药物治疗已被广泛应用于临床。目的回顾性观察腹腔镜手术联合“内异消散方”治疗子宫内膜异位症的临床效果,为子宫内膜异位症提供更好的治疗方案,旨在降低患者的复发率及提高其妊娠率。研究对象与方法选取2006年1月至2016年1月于我院接受治疗的子宫内膜异位症403例(均有迫切生育要求、手术为同一术者)进行回顾性分析研究。按照治疗方法的不同,分为对照组和观察组,其中对照组患者采取的是腹腔镜手术(拒绝术后应用药物),共200例;观察组患者是在实施腹腔镜手术的基础上联合内异消散方进行治疗,共203例。观察两组患者的手术效果,即术后疼痛症状缓解率、异位症的复发率、不孕患者的妊娠率、生化指标CA-125情况等。采用电话或门诊复诊的形式进行为期1年的随访,对患者的临床资料进行对比,分析其结果及影响因素。1.对照组平均年龄为(29.98±4.60)岁,平均不孕病史为(3.60±2.85)年,平均月经周期为(31.09±3.55)天;观察组平均年龄为(30.60±4.40)岁,平均不孕病史为(3.05±2.78)年,平均月经周期为(30.12±4.56)天。两组患者的年龄、不孕病史以及月经周期方面的比较,差异无统计学意义(P0.05),具有可比性。2.对照组手术Ⅲ期患者有127例,百分比为63.64%,手术Ⅳ期患者有73例,百分比为36.36%;观察组患者手术Ⅲ期患者有124例,百分比为60.87%,手术Ⅳ期患者有79例,百分比为39.13%。比较两组患者的手术分期,没有明显差距,差异无统计学意义(P0.05),具有可比性。3.对两组患者治疗前主要症状比较(除外非内异症所致),对照组下腹痛患者有100例(50.0%),性交痛患者110例(55.0%),腰骶部不适患者106例(53.0%),痛经患者164例(82.0%),肛门坠胀感患者131例(65.2%);观察组下腹痛患者有101例(49.8%),性交痛患者104例(51.4%),腰骶部不适患者99例(48.9%),痛经患者170例(83.9%),肛门坠胀感患者129例(63.3%)。对两组患者治疗前主要症状进行比较,差异无统计学意义(P0.05),具有可比性。结果1.对照组治疗前下腹痛积分为0患者有83例,治疗后患者为94例;性交痛积分为0患者有85例,治疗后患者为95例;腰骶部不适积分为0患者有47例,治疗后患者为77例;痛经积分为0患者有64例,治疗后患者为114例;有肛门坠胀感积分为0患者有86例,治疗后患者为94例;观察组治疗前下腹痛积分为0患者有76例,治疗后患者为100例;性交痛积分为0患者有78例,治疗后患者为101例;腰骶部不适积分为0患者有43例,治疗后患者为80例;痛经积分为0患者有61例,治疗后患者为140例;有肛门坠胀感积分为0患者有86例,治疗后患者为97例,两组比较,差异有统计学意义(P0.05)。2.对照组患者术后3、6、9及12个月的自然受孕率分别为25.4%,35.5%,33.1%和30.1%;辅助生殖受孕率分别为33,3%,40.%0,36.4%和35.3%;观察组患者术后3、6、9及12个月的自然受孕率分别为38.9%,45.4%,42.2%和40.3%;辅助生殖受孕率分别为41.3%,48.9%,45.3%和42.1%。对照组和观察组不同时期的自然受孕率和辅助生殖受孕率进行比较,差异均有统计学意义(P㩳0.05)。3.对照组手术前CA-125含量为(55.60±48.40)U/ml,术后1个月CA-125含量为35.60±28.39U/ml,术后3个月CA-125含量为(28.23±16.06)U/ml,术后12个月CA-125含量为(50.37±18.80)U/ml;观察组手术前CA-125含量为(56.98±47.60)U/ml,术后1个月CA-125含量为(36.98±27.49)U/ml,术后3个月CA-125含量为(26.50±17.60)U/ml,术后12个月CA-125含量为(41.17±16.99)U/ml。两组患者治疗后体内CA-125水平均下降后再上升,术前两组CA-125水平具有可比性,术后12个月的CA-125水平进行比较,观察组低于对照组,差异均有统计学意义(P㩳0.05)。4.对照组术后3个月复发患者有5例(2.5%),术后6个月复发患者有15例(7.5%),术后1年复发患者有30例(15.0%),累积复发率为25%;观察组术后3个月复发患者有1例(0.5%),术后6个月复发患者有2例(1.0%),术后1年复发患者有21例(10.3%),累积复发率为12%。两组患者术后复发率均随时间的增长而升高,同期比较,观察组复发患者少于对照组。对两组患者患者复发情况进行比较,差异具有统计学意义(P㩳0.05)。5.患者病程(年)、有盆腔手术史、体重指数(kg/m2)、术前孕次、术前产次对子宫内膜异位症的复发情况影响不大,差异无统计学意义(P0.05)。患者有术后用药、r㧟AFS分期情况对子宫内膜异位症的复发情况影响较大,差异具有统计学意义(P0.05)。结论腹腔镜手术联合内异消散方可以有效的缓解子宫内膜异位症患者的疼痛症状,在一定程度上控制CA-125水平升高,提高患者妊娠率,降低术后复发率。
[Abstract]:The background of endometriosis (endometriosis, EMS) refers to the cultivation of endometrial cells active in endometrial position outside a gynecological disease formed. The incidence of the disease is dependent on estrogen, so the incidence of common in women of childbearing age, the incidence of symptoms mainly show as infertility, abnormal menstruation, dysmenorrhea and sexual intercourse pain, prone to recurrence and metastasis. Currently, surgery is the preferred treatment for the treatment of the disease, and has become a widely used treatment. Because the disease conservative surgery and postoperative recurrence, in order to make some small residual in pathogenic factor is inhibited, and even atrophy degeneration, to delay the recurrence and cure objective after surgery combined with drug therapy has been widely used in clinical. Objective To retrospectively observe laparoscopic surgery combined with EM dissipation party "clinical effect in the treatment of endometriosis, uterine endometriosis In providing better treatment options, to reduce the recurrence rate and improve the pregnancy rate. 403 cases of endometriosis subjects and methods from January 2006 to January 2016 in our hospital (both urgent surgery planning requirements, for the same patient) were retrospectively analyzed. According to the different methods of treatment. Divided into control group and observation group, the patients in the control group were taken laparoscopic surgery (drug refused postoperative), a total of 200 cases; patients in the observation group is performed based on dissipation of endometriosis laparoscopic surgery on the treatment, a total of 203 cases. Observe the clinical effect of the two groups of patients, the postoperative pain the remission rate, the recurrence rate of endometriosis patients with infertility, pregnancy rate, biochemical indexes of CA-125. By telephone or outpatient department in the form of a period of 1 years of follow-up, the clinical data of the patients were compared, analysis of the The results and influencing factors of.1. control group average age (29.98 + 4.60) years old, the average for the history of infertility (3.60 + 2.85) years, the average menstrual cycle is (31.09 + 3.55) days; the observation group average age (30.60 + 4.40) years old, the average for the history of infertility (3.05 + 2.78) years, the average menstrual cycle (30.12 + 4.56) days. The two groups in age, infertility and menstrual cycle compared to the difference was not statistically significant (P0.05), with patients who were in stage III in 127 cases of.2. group, percentage of 63.64% patients with stage IV in 73 cases, accounted for 36.36%; observation in group III 124 cases, accounted for 60.87%, 79 cases of patients with stage IV, the percentage of 39.13%. of two groups were compared with surgical staging, no significant difference, the difference was not statistically significant (P0.05), comparable.3. comparison of main symptoms of patients in two groups before treatment (except non endometriosis 鎵，
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