腹腔镜联合药物治疗卵巢子宫内膜异位囊肿疗效分析(1)
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[摘要] 目的 探讨腹腔镜联合药物治疗卵巢子宫内膜异位囊肿的疗效。 方法 将239例经腹腔镜保守治疗的卵巢子宫内膜异位囊肿患者分为三组：未用药物组(对照组)73例，GnRH-a组52例，孕三烯酮组114例，分析三组患者术后复发率及两种药物的副作用发生率。 结果 术后随访18～42个月，对照组复发率高于GnRH-a组和孕三烯酮组(P < 0.05﹚，GnRH-a组与孕三烯酮组比较差异无统计学意义(P > 0.05)，但GnRH-a组副作用发生率低于孕三烯酮组。 结论 腹腔镜保守治疗术后应用GnRH-a类药物或孕三烯酮胶囊均可降低卵巢子宫内膜异位囊肿复发率，但GnRH-a类药物副作用发生率明显低于孕三烯酮。
[关键词] 卵巢子宫内膜异位囊肿；腹腔镜；GnRH-a类药物；孕三烯酮
[中图分类号] R713 [文献标识码] B [文章编号] 1673-9701(2012)06-0159-02
Efficacy of laparoscopic surgery and post-operation medicine for ovarian endometrioma
GENG Suling GAO Xiang HAN Yina SHEN Airong
Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
[Abstract] Objective To evaluate the efficacy of laparoscopic surgery and post-operation medicine for ovarian endometrioma. Methods All of 239 patients with ovarian endometrioma who were treated with ovarian cystectomy performed by laparoscopy were divided into three groups: untreated group, GnRH-a group, gestrinone group. The recurrence rate of the three groups and the side effects of the two kinds of medicine were compared. Results All the patients were followed up for 18 to 42 months, and the incidence of recurrence in the untreated group was higher than in GnRH-a group and gestrinone group (P < 0.05), but there was no statistically significant difference between GnRH-a group and gestrinone group (P > 0.05). The incidence of side effect in GnRH-a group was lower than gestrinone group. Conclusion Laparoscopic surgery is an effective way to treat ovarian endometrioma, and the use of GnRH-a or gestrinone after operation can reduce the incidence of recurrence, but the incidence of side effect in the gestrinone group is higher.
[Key words] Ovarian endometrioma; Laparoscopy; GnRH-a; Gestrinone
卵巢子宫内膜异位囊肿是子宫内膜异位症最常见的一种类型[1]，多发生在育龄期妇女，以痛经、慢性盆腔痛、不孕为主要表现。目前手术尤其是腹腔镜保守性手术，因其在症状改善和利于受孕方面优于药物，而被认为是首选治疗方法，但术后复发率高，2年复发率为21.5%，5年复发率为40%～50%[2]，因此，术后药物治疗非常必要。本文对腹腔镜手术联合药物治疗卵巢子宫内膜异位囊肿临床效果进行了分析。
1 资料与方法
1.1 一般资料
收集2008年1月～2009年12月在我院妇科诊治并经病理诊断为卵巢子宫内膜异位囊肿的患者239例，年龄19～40岁，平均(31±5)岁，所有患者均行腹腔镜下卵巢囊肿剥除术。囊肿位于左侧卵巢者98例，位于右侧者81例，侵犯双侧卵巢者60例；囊肿直径3～13 cm，平均(5.1±1.8) cm。78例患者无任何症状，仅在彩超检查时发现卵巢囊肿，112例存在痛经症状，33例出现非经期间断下腹痛，15例同时存在痛经及非经期下腹痛，另有1例卵巢囊肿自发破裂出现突发下腹痛。合并不孕的患者57例，术中发现盆腔粘连者159例。
1.2 治疗及随访
所有患者均成功剥离卵巢囊肿，首先恢复盆腔正常解剖 ......
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