卵巢子宫内膜异位症术后复发的原因分析

发布时间：2018-04-04 02:30

本文选题：卵巢子宫内膜异位症　切入点：术后复发　出处：《吉林大学》2015年硕士论文

【摘要】：目的：卵巢子宫内膜异位症（Ovarian endometriosis，简称OM）是妇科常见病及多发病，近年来其患病率明显增高。常见症状主要为痛经、性交痛和不孕。临床治疗以减灭病灶、减轻症状和促进生育为目的。由于卵巢子宫内膜异位症保守性手术术后复发率高，国内外学者更加关注影响术后复发的相关因素。本研究通过回顾性分析，探讨复发的相关因素，寻找对应的干预措施。方法：抽取吉林大学第二医院妇产科医院2010年12月-2012年12月间因OM行保守性手术的患者377例，将随访发现复发的病例作为观察组，未复发的病例作为对照组，进行回顾性分析。根据复发率、回归系数等各项指标的比较，找出相关因素。结果：1、OM保守性手术术后2年复发率为13.73%（49/357）。 2、各年龄段分组的复发率18岁组为0%（0/3）、18-45岁组为15.33%（49/322）、45岁组为0%（0/32）。既往无人流史的复发率为13.74%（29/211），1次人流史的复发率为8.25%（8/97）,2次人流史的复发率为10.34%（3/29），3次及以上人流史的复发率为45%（9/20）。手术途径中经腹手术组的复发率为17.78%（40/225），腹腔镜手术组的复发率为6.82%（9/132）。术后用药组的复发率为6.31%（7/111），，术后未用药组的复发率为17.07%（42/246）。术后有妊娠史组的复发率为3.26%(3/92)，无妊娠史组的复发率为17.36%（46/225）。初次手术时单侧发病组的复发率为9.2%（16/174），双侧发病组的复发率为18.00%（33/183）。包块大小各组的复发率，5cm组为5.5%（3/54），5-10cm组为12.7%（26/204），10cm组为20.2%（20/99）。有痛经组的复发率为15.88%（44/277），无痛经组的复发率为6.25%（5/80）。合并腺肌症组的复发率为22.34%（21/94）,未合并腺肌症组的复发率为10.65%（28/263）。以上各变量的组内复发率比较，P均0.05,有统计学意义。 3、单因素Logistic回归分析结果：首次发病年龄、痛经与否、人流史及次数、术后用药与否、初次手术时单双侧、手术途径、术后妊娠与否、包块大小、合并腺肌病与否的wald值分别为6.049、4.866、19.258、7.488、5.883、8.439、11.462、6.865、7.997（P值均＜0.05）。 4、多因素Logistic回归分析结果:首次发病年龄、痛经与否、人流史及次数、初次手术的单双侧、包块大小、合并腺肌病与否的OR值均＞1，且上述因素的回归系数β＞0(正相关)，其中既往人流史、痛经史、包块大小的OR＞3；发病年龄、合并腺肌病的OR＞1.5。术后有妊娠史、术后辅助用药、手术途径为腹腔镜的OR＜1，且回归系数B＜0(负相关)。结论：1、卵巢子宫内膜异位症复发的独立因素有首次发病年龄、痛经与否、人流史及次数、术后用药与否、初次手术时单双侧、手术途径、术后妊娠与否、包块大小、合并腺肌病与否。 2、首次发病年龄、痛经与否、人流史及次数、初次手术的单双侧、包块大小、合并腺肌与否这6个因素可能是卵巢子宫内膜异位症复发的危险因素。其中既往有人流史、合并痛经、初次手术时的包块大有可能为强危险因素;首次发病年龄、合并腺肌病可能是中等危险因素; 3、术后有妊娠史、术后辅助用药、手术途径为腹腔镜可能是卵巢子宫内膜异位症术后复发的保护因素。 4、对于生育期的女性复发率高，手术途径选取腹腔镜可能降低复发率，术后应指导患者规范的用药或术后妊娠，必要时辅以助孕技术。
[Abstract]:Objective : The incidence of endometriosis ( OM ) in ovarian endometriosis has been significantly increased in recent years . The common symptoms are dysmenorrhea , sexual intercourse and infertility . Clinical treatment is aimed at reducing the focus , reducing symptoms and promoting fertility .

Methods : From December 2010 to December 2012 in the Second Hospital of Jilin University from December 2010 to December 2012 , 377 patients with conservative operation of OM were selected , and the cases with recurrence were taken as observation group , and the cases with no recurrence were taken as control group , and the correlation factors were found according to the comparison of recurrence rate and regression coefficient .

Results : 1 . After operation , the recurrence rate was 13.73 % ( 49 / 357 ) .

The recurrence rate of the group was 13.74 % ( 29 / 211 ) . The recurrence rate of non - pregnant group was 13.74 % ( 29 / 211 ) . The recurrence rate of the two groups was 13.74 % ( 29 / 211 ) .

3 . The results of single - factor logistic regression analysis were as follows : first onset age , dysmenorrhea , history of abortion , number of times of abortion , postoperative medication or not . The wald values of single and bilateral , surgical approaches , post - operative pregnancy , the size of the pack , and the absence of combined adenomyopathy were 6.49 , 4.866 , 19.258 , 7.488 , 5.883 , 8.439 , 11.462 , 6.865 , 7.997 ( P < 0.05 ) .

4 . Multiple Logistic Regression Analysis Results : The OR value of first onset age , dysmenorrhea , flow history and number of times , single and double sides of primary surgery , size of bag , OR of combined adenomyopathy > 1 , and regression coefficient 尾 > 0 ( positive correlation ) of the above factors , including previous history of human history , history of dysmenorrhea , OR > 3 of packet size ;
OR > 1.5 . There was a history of pregnancy and auxiliary medication after operation . The operative route was OR < 1 , and the regression coefficient was B < 0 ( negative correlation ) .

Conclusion : 1 . The independent factors of recurrence of endometriosis include first onset age , dysmenorrhea , history of abortion , number of times of abortion , postoperative medication , single and double side , surgical approach , postoperative pregnancy or not , size of the block , and the presence or absence of combined adenopathy .

2 . The six factors such as age , dysmenorrhea , history and frequency of abortion , single and double sides of primary surgery , size of pack and whether combined adenoids may be a risk factor for the recurrence of endometriosis .

3 . There is a history of pregnancy and auxiliary medication after operation , which may be a protective factor for the recurrence of endometriosis after operation .

4 . For the high recurrence rate of female in the growing period , it is possible to reduce the recurrence rate by selecting the laparoscopic approach for the surgical approach , which should guide the medication or post - operative pregnancy of the patient ' s standard , and assisted with the technique of contraception if necessary .

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R711.71

【参考文献】