“曼月乐”联合MURU治疗子宫腺肌病的临床研究

发布时间：2018-05-13 19:11

本文选题：肌壁大部切除-子宫重建术 + 曼月乐　；参考：《遵义医学院》2014年硕士论文

【摘要】：目的:研究肌壁大部切除-子宫重建术（major uterine wall resection and reconstructionof the uterus, MURU）联合曼月乐（Mirena, levonorgestrel-releasing intrauterine system,LNG-IUS）治疗子宫腺肌病（adenomyosis,AMS）的安全性及疗效，为子宫腺肌病分度及按分度选择治疗方案的设想和保留子宫的治疗目的提供依据。方法：根据超声子宫单侧肌壁厚度（前壁、后壁或宫底）或腺肌瘤最大直径将子宫腺肌病分为轻、中、重三度。对70例中、重度腺肌症患者行MURU术并于术中放置曼月乐，记录MURU的手术时间、术中出血量、切除病灶（肌壁）重量、体积及治疗后3个月、12个月及18个月病人痛经程度、经量、子宫体积、CA125，，并与术前比较，评估MURU手术的安全性及MURU+曼月乐治疗腺肌病的临床疗效。结果：70例病人MURU术均获成功，平均手术时间、出血量、住院时间分别为（143.76±27.00）min、（52.39±14.79）ml、4.60±0.57d。术前子宫平均体积267.57±107.18cm3，切除子宫肌壁的平均重量、平均体积分别为310.35±71.26g、214.63±106.15cm3，与正常育龄妇女子宫比较，MURU术后子宫体积平均缩小3.42倍；切除肌壁的重量为正常子宫重量的5.17倍。治疗后3个月、12个月和18个月的痛经评分、经量评分、子宫体积、CA125均显著低于术前水平（P0.05）。所有接受MURU+曼月乐治疗的患者经术后密切随访至今，均无曼月乐脱落、嵌顿或异位发生，均未出现肥胖、脱发、潮热、阴道干涩、性交痛等不适。结论: MURU手术是安全的。MURU联合曼月乐治疗中、重度子宫腺肌病的疗效非常显著。
[Abstract]:Objective: to study the safety and efficacy of major uterine wall resection and reconstructionof the uterus, MURU) combined with levonorgestrel-releasing intrauterine system LNG-IUSin the treatment of adenomyosis. To provide the basis for the classification of adenomyosis and the selection of the treatment scheme according to the grading and the purpose of the treatment of uterine preservation. Methods: according to the thickness of unilateral uterine wall (anterior wall, posterior wall or uterine floor) or the maximum diameter of adenomyoma, adenomyosis was divided into three degrees: mild, moderate and severe. MURU was performed in 70 patients with severe adenomyosis. The time of MURU operation, the amount of intraoperative bleeding, the weight of lesion (muscle wall), the volume and the degree of dysmenorrhea were recorded, including 3 months, 12 months and 18 months after treatment. To evaluate the safety of MURU operation and the clinical effect of MURU manyue in the treatment of adenomyosis. Results the MURU procedure was successful in 70 patients. The average operation time, blood loss and hospitalization time were 52.39 卤14.79 ml / min and 4.60 卤0.57 days, respectively. The mean volume of uterus was 267.57 卤107.18 cm ~ (3) before operation, and the mean weight of muscle wall was 310.35 卤71.26 g / g ~ (214.63 卤106.15) cm ~ (3), which was 3.42 times smaller than that of normal womb and 5.17 times of normal uterus. After 3 months, 12 months and 18 months of treatment, the score of dysmenorrhea and the volume of uterine volume CA125 were significantly lower than the preoperative level of P0. 05%. All the patients who received MURU Manyue were followed up closely after the operation. No Manyue shedding, incarceration or ectopic, no obesity, alopecia, hot flashes, dry vagina, intercourse pain and other discomfort. Conclusion: MURU is a safe and effective method in the treatment of severe adenomyosis.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.71

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