不同手术方法治疗卵巢子宫内膜异位症的疗效分析

发布时间：2018-04-26 21:18

本文选题：卵巢子宫内膜异位症 + 腹腔镜　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：通过对腹腔镜和开腹手术两种方法治疗卵巢子宫内膜异位症的疗效观察，综合各项指标分析腹腔镜手术和开腹手术的临床意义，以期达到对其手术治疗方法更全面的认识，为其治疗提供一定的理论基础。方法：收集吉林大学白求恩第一医院妇产科2011年1月至2013年1月期间收治的208例卵巢子宫内膜异位症患者，，根据患者自愿选择手术方式的原则分为腹腔镜和开腹2组。采用回顾性病例对照分析的方法对2组患者年龄、囊肿大小，内异症分期及CA125水平、手术方式、手术时间、术中出血量、术后排气时间、住院时间、症状缓解预后恢复等几个方面进行分析。结果：1、两组患者手术情况比较，腹腔镜手术及传统开腹手术均能顺利完成，其中1例腹腔镜手术中转开腹。腹腔镜组的手术时间、术中出血量、术后排气时间、住院时间、术后发热时间明显少于开腹组，两组差异有统计学意义（P0.05）。2、2组术后并发症比较，腹腔镜组术后无并发症发生。开腹手术组有1例出现切口脂肪液化，给予对症处理后切口愈合良好，其余两组切口均甲级愈合。3、2组术后复发情况比较，所有患者均从手术后1个月后开始定期进行门诊复查，随访6-24个月。其中术后复发5例，均为一侧卵巢囊肿剥除术后患者，其中腹腔镜组3例，开腹组2例。其中4例进行保守治疗，1例再次行腹腔镜治疗后治愈。两组复发率比较差异不显著无统计学意义。（P0.05）4、有生育要求的40例患者中，采取传统开腹手术共计18例，术后随访有4例患者妊娠（22、22%），其中1年内妊娠0人。采取腹腔镜手术患者22例，5例妊娠（22、72%），其中1年内妊娠2人。结论： 1、腹腔镜手术术中出血量、手术时间、术后排气时间、住院时间、术后发热时间等方面要明显低于开腹手术。。 2、腹腔镜手术住院时间短，术后疼痛轻，患者疤痕小，恢复快。如果术后复发，再次手术创伤小，切口愈合快。 3、接受开腹手术和腹腔镜手术两种术式的患者的复发率、妊娠率及术后临床症状缓解率的改善情况相似。 4、手术治疗是卵巢子宫内膜异位症的首选方法，主要为传统的开腹手术和腹腔镜手术，术式的选择应根据患者年龄、生育要求及临床症状做到个体化。
[Abstract]:Objective: to observe the curative effect of laparoscopy and laparotomy in the treatment of ovarian endometriosis, and to analyze the clinical significance of laparoscopy and laparotomy. In order to achieve a more comprehensive understanding of its surgical treatment, to provide a certain theoretical basis for its treatment. Methods: 208 patients with ovarian endometriosis admitted from January 2011 to January 2013 in the first Hospital of Gynecology and Obstetrics of Jilin University were divided into two groups: laparoscopy and laparotomy according to the principle of voluntary choice of surgical methods. The age, size of cysts, staging of endometriosis and CA125 level, operation mode, operative time, intraoperative bleeding volume, postoperative exhaust time, hospital stay were analyzed by retrospective case-control analysis. Symptom relief, prognosis recovery and other aspects were analyzed. Results compared with the two groups, laparoscopic surgery and traditional open surgery were performed successfully, one of them was converted to open surgery. The operative time, intraoperative bleeding volume, postoperative exhaust time, hospitalization time and postoperative fever time in the laparoscopy group were significantly less than those in the open group. The difference between the two groups was statistically significant (P 0.05). There were no postoperative complications in the laparoscopy group. The incision fat liquefaction occurred in 1 case in the open operation group, and the incision healed well after the symptomatic treatment. The recurrence of the other two groups was compared after operation. All the patients began to carry out regular outpatient reexamination one month after the operation. Follow-up 6-24 months. Among them, 5 cases recurred after operation, all of them were treated with unilateral ovarian cyst excision, including laparoscopic group (3 cases) and open group (2 cases). Among them, 4 cases received conservative treatment and 1 case was cured by laparoscopy. There was no significant difference in the recurrence rate between the two groups. There was no significant difference between the two groups. Among the 40 patients with fertility requirement, 18 cases were treated with traditional open surgery. 4 cases were followed up after operation, among which 0 cases were pregnant within 1 year. 22 cases of laparoscopy were performed in 5 cases of pregnancy, among which 2 cases were pregnant within 1 year. Conclusion: 1.The amount of blood loss, operative time, postoperative exhaust time, hospitalization time and postoperative fever time in laparoscopic surgery were significantly lower than those in laparotomy. 2.Laparoscopic surgery has short hospitalization time, mild postoperative pain, small scar and quick recovery. If recurrence occurs again, the wound will be minimal and the incision will heal quickly. 3. The recurrence rate, pregnancy rate and relief rate of clinical symptoms of patients undergoing laparoscopy and open surgery were similar. 4, surgical treatment is the first choice of ovarian endometriosis, mainly for the traditional laparotomy and laparoscopic surgery, the choice of operation should be individualized according to the patient's age, fertility requirements and clinical symptoms.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.6

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