三种不同术式治疗子宫腺肌病的临床疗效及分析

发布时间：2018-06-23 17:12

本文选题：腹腔镜 + 子宫腺肌病　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:子宫腺肌病(简称腺肌症)(adenomyosis,AM)是指异位内膜浸润正常的子宫肌层,周围平滑肌细胞增生包裹异位的内膜上皮和基质而形成病灶。腺肌病的渐进性痛经及不孕症状给患者带来很大生活压力及身心痛苦。临床中常把子宫腺肌病患者归为两类:有生育要求和无生育要求。面对无生育要求的子宫腺肌病患者,临床最常采用的手术方法是全子宫切除术,但是这种术式常出现卵巢功能下降,残留卵巢综合症,性功能下降等并发症。本课题通过三种不同的术式治疗子宫腺肌病,探寻一种疗效显著且能保护女性患者卵巢功能的手术方法。方法:2014年1月至2016年1月入院因子宫腺肌病行手术治疗的患者病历,按照纳入及排出标准,最终选择91例进行回顾性分析。该91例包括3组:观察组为腹腔镜下三角形子宫切除术(laparoscopic deltoid hysterectomy,LDH)组(30例),对照组分别为腹腔镜下全子宫切除术(laparoscopic total hysterectomy,LTH)组(32例)、腹腔镜下次全子宫切除术(laparoscopic subtotal hysterectomy,LSH)组(29例)。观察手术时间、术中出血量、术后3个月、术后半年及1年的卵巢功能改变、术后1年的腹痛程度改变、B超改变及并发症等指标。结果:LDH组的手术时间与LTH、LSH组无差异(p0.05);LDH组的出血量与LTH、LSH组无差异(p0.05);LDH组术前与术后3个月、术后半年、术后1年的黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle-stimulating hormone,FSH)、抗苗勒氏管激素(anti-mullerian hormone,AMH)值得比较均无显著变化(p0.05);LTH组术前与术后3个月LH、FSH、AMH值得比较均无显著变化(p0.05),但术后半年、术后1年的LH、FSH值显著性升高(p0.05),AMH值均显著降低(p0.05);LSH组术前与术后3个月、术后半年LH、FSH、AMH值的比较均无显著变化(p0.05),但术后1年的LH、FSH值均显著性升高(p0.05),AMH值显著性降低(p0.05)。LDH、LTH、LSH三组在治疗子宫腺肌病患者腹痛疗效方面,差异均无统计学意义(p0.05);而三组手术在腹痛程度改变方面各自的术前与术后1年比较,差异有统计学意义(p0.05)。结论:1、腹腔镜下三角形子宫切除术治疗子宫腺肌病疗效显著,术后并发症少,且能保护卵巢功能,符合无生育要求子宫腺肌病患者的生理及心理需求,值得临床推广。2、腹腔镜下三角形子宫切除术不增加手术时间与出血量,与腹腔镜下全子宫切除术、腹腔镜下次全子宫切除术相似。
[Abstract]:Objective: adenomyosis (AM) refers to the ectopic endometrium infiltrating the normal myometrium and the peripheral smooth muscle cells proliferating around the ectopic endometrial epithelium and matrix. Progressive dysmenorrhea and infertility of adenomyosis bring great life pressure and physical and mental pain. Clinical adenomyosis is often classified into two categories: fertility requirements and fertility requirements. Total hysterectomy is the most common surgical method in patients with adenomyosis without fertility requirements. However, the complications such as ovarian dysfunction, residual ovarian syndrome and sexual dysfunction are often found in this procedure. In this study, three different surgical methods were used to treat adenomyosis and to find a method that can protect the ovarian function of female patients. Methods: from January 2014 to January 2016, 91 patients with adenomyosis who were admitted to hospital for surgical treatment were retrospectively analyzed according to the criteria of inclusion and exclusion. The 91 cases were divided into three groups: the observation group (30 cases), the control group (32 cases) and the next laparoscopic hysterectomy group (laparoscopic subtotal hysterectomytomy LSH) group (29 cases), the observation group (30 cases), the control group (32 cases), the next laparoscopic hysterectomy group (laparoscopic subtotal hysterectomyl LSH) group (30 cases), the control group (32 cases), the next laparoscopic hysterectomy group (laparoscopic subtotal hysterectomytomy LSH) group (29 cases). The time of operation, the amount of intraoperative bleeding, the changes of ovarian function in 3 months, 6 months and 1 year after operation, the degree of abdominal pain in 1 year after operation, the changes of B-ultrasound and complications were observed. Results there was no significant difference in the operative time between the two groups (p0.05). There was no difference in the amount of blood loss between the LDH group and the LTHH LSH group (p0.05). There was no difference between the two groups before and after operation (p0.05), and there was no difference between the two groups before and after operation (p0.05). There were no significant changes in luteinizing hormone LH, follicle-stimulating moneystimulating hormone, anti-mullerian moneymotropin (p0.05) before and 3 months after operation in LTH group (p0.05), but no significant changes were found in half a year after operation (p0.05), but there was no significant difference between the two groups (p0.05), but there was no significant difference between them before and after operation (p0.05), but half a year after operation, there was no significant difference between the two groups (p0.05), but half a year after operation, there was no significant difference between the two groups (p0.05). One year after operation, the FSH value of LHG increased significantly (p0.05) and AMH decreased significantly (p0.05) in LSH group before operation and 3 months after operation. There was no significant change in AMH value in half a year after operation (p0.05), but the value of FSH increased significantly (p0.05) and AMH significantly decreased (p0.05). LDH LTHH LSH in the three groups in the treatment of abdominal pain in patients with adenomyosis was significantly higher (p0.05), and the value of AMH was significantly decreased (p0.05) in the treatment of abdominal pain in patients with adenomyosis. There was no significant difference in the degree of abdominal pain between the three groups (p0.05), and there was a significant difference in the degree of abdominal pain between the three groups before operation and one year after operation (p0.05). ConclusionLaparoscopic triangular hysterectomy is effective in the treatment of adenomyosis with fewer complications, and can protect ovarian function and meet the physiological and psychological needs of patients with adenomyosis without fertility. It is worth popularizing. 2. Laparoscopic triangular hysterectomy does not increase the operative time and blood loss. It is similar to total hysterectomy under laparoscope and the next total hysterectomy under laparoscope.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4

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