腹腔镜子宫腺肌病灶切除术术后复发危险因素分析

目的:探讨腹腔镜子宫腺肌病灶切除术术后复发情况及其相关临床危险因素。方法:分析2010年1月—2015年1月在首都医科大学附属北京妇产医院妇科微创中心行腹腔镜子宫腺肌病灶切除术的109例患者临床资料,随访术后复发情况,分析患者术后复发的相关临床因素。结果:术后12、24、36个月的累积复发率分别为14.9%、22.7%及25.7%。年龄对术后复发率有显著影响,年龄每增加1岁,复发风险就降低10%(RR=0.900,95%CI:0.822～0.986,P=0.023);术前子宫体积增大是术后复发高危因素(RR=1.289,95%CI:1.121～1.678,P=0.005);术后促性腺激素释放激素激动剂(GnRHa)治疗是术后复发保护性因素(RR=0.407,95%CI:0.185～0.895,P=0.025)。患者的孕次、术前痛经评分、最大腺肌瘤直径、腺肌瘤位置、术前药物治疗、手术方式、合并子宫内膜异位症等均不是增加术后复发率的危险因素。结论:患者年龄小、术前子宫体积增大、术后未应用GnRHa治疗是腹腔镜子宫腺肌病灶切除术术后复发率增加的危险因素。

Study on Recurrence Risk Factors after Laparoscopic Adenomyomectomy

Objective：To investigate the clinical recurrence risk factors after laparoscopic adenomyoectomy. Methods：From Jan. 2010 to Jan. 2015, 109 patients undering laparoscopic adenomyomectomy were recruited in Gynecologic Minimally Invasive Center of Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University were recruited. The patients demographic, clinic characteristics, preoperative and postoperative information was reviewed and analyzed. Gonadotropin-releasing hormone agonist (GnRHa) therapy, surgical approach, follow-up information was also collected. Results：The culmulative rate of 12, 24 and 36 months after operation was 14.9%, 22.7% and 25.7% respectively. Age had a significant effect on postoperative recurrence rate. With the age increasing，the risk of relapse decreased 10% (RR=0.900, 95%CI: 0.822-0.986, P=0.023). The preoperative uterine volume was the risk factor of postoperative recurrence (RR=1.289, 95%CI: 1.121-1.678, P=0.005). Postoperative GnRHa therapy was a protective factor for postoperative recurrence (RR=0.407, 95%CI: 0.185-0.895, P=0.025). The patient′s pregnancy history, the preoperative dysmenorrhea score, the maximum size of the adenoma, the position of the adenoma, preoperative GnRHa therapy, surgical approach and endometriosis were not risk factors for postoperative recurrence rate. Conclusions：The age, preoperative uterine volume and no postoperative GnRHa therapy are the risk factors for recurrence after laparoscopic hysterectomy.