无气腹腹腔镜下改良环形电切术病灶切除联合药物治疗子宫腺肌病疗效研究

发布时间：2018-07-26 12:29

【摘要】：目的探讨无气腹腹腔镜下改良环形电切术(LEEP)切除子宫腺肌病病灶,并联合应用促性腺激素释放激素类似物(Gn RHa)和左炔诺孕酮宫内释放系统(LNG-IUS)治疗子宫腺肌病保留子宫的临床效果。方法 2010年8月至2013年7月对上海市闸北区中心医院和上海交通大学医学院附属第九人民医院收治的子宫腺肌病患者60例进行前瞻性研究。首先在无气腹腹腔镜下应用改良LEEP术切除子宫腺肌病病灶,同时应用Gn RHa治疗6个月,然后宫内放置LNG-IUS。观察治疗前后患者临床表现和检查指标的变化。结果 60例患者均完成手术和Gn RHa治疗,58例患者宫内放置LNG-IUS。手术后6个月和12个月子宫体积显著减小,术后18个月子宫体积有所增大,但仍显著小于手术前。手术前血红蛋白(88.8±11.7)g/L,术后3个月即恢复正常。手术前CA125升高41例,术后3个月均降至正常,术后18个月仍在正常水平。55例术前月经过多患者均放置LNG-IUS,手术后12个月和18个月月经量均达到或接近正常。术前共43例痛经者中42例放置LNG-IUS,手术后12和18个月痛经VAS评分均显著低于手术前(P0.01),术后18个月痛经评分有所增加,但与术后12个月差异无统计学意义(P0.05)。结论无气腹腹腔镜下改良LEEP术可较满意地切除子宫腺肌病病灶,联合Gn RHa治疗可显著减小子宫体积,改善临床症状,LNG-IUS的应用可进一步巩固治疗效果。
[Abstract]:Objective to investigate the effect of modified ring electrotomy (LEEP) under pneumoperitoneum on adenomyosis. The clinical effect of combined use of gonadotropin releasing hormone analogue (Gn RHa) and levonorgestrel intrauterine release system (LNG-IUS) in the treatment of uterine adenomyosis was studied. Methods from August 2010 to July 2013, 60 patients with adenomyosis treated in Shanghai Zhabei Central Hospital and the Ninth people's Hospital affiliated to Shanghai Jiaotong University Medical College were studied prospectively. The lesions of adenomyosis were resected by modified LEEP under pneumoperitoneum laparoscopy, then treated with Gn RHa for 6 months, then intrauterine LNG-IUSs were placed. The changes of clinical manifestations and examination indexes were observed before and after treatment. Results all the 60 patients underwent surgery and 58 patients received Gn RHa intrauterine placement of LNG-IUS. The uterine volume decreased significantly at 6 and 12 months after operation, and increased at 18 months after operation, but was still significantly smaller than that before operation. Hemoglobin (88.8 卤11.7) g / L before operation returned to normal 3 months after operation. CA125 increased in 41 cases before operation and decreased to normal at 3 months after operation. After 18 months, 55 patients with menorrhagia were treated with LNG-IUS.The menstrual volume reached or approached normal at 12 and 18 months after operation. 42 of 43 patients with dysmenorrhea were treated with LNG-IUS.The VAS scores at 12 and 18 months after operation were significantly lower than those before operation (P0.01). The scores of dysmenorrhea increased at 18 months after operation, but there was no significant difference between them (P0.05). Conclusion modified LEEP under pneumoperitoneum laparoscopy can remove adenomyosis lesions satisfactorily, combined with Gn RHa can significantly reduce uterine volume and improve clinical symptoms. LNG-IUS can further consolidate the therapeutic effect.
【作者单位】：上海中医药大学附属曙光医院妇产科;上海交通大学医学院附属第九人民医院妇产科;
【分类号】：R711.71

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