卵巢子宫内膜异位囊肿的腹腔镜手术治疗

目的:探讨腹腔镜手术治疗卵巢子宫内膜异位囊肿的疗效及可行性。方法:回顾性总结了2003年5月~2004年12月在北京大学第一医院妇科腹腔镜手术治疗卵巢子宫内膜囊肿(R-AFS分期Ⅱ~Ⅳ期)的患者189例。结果:189例均在腹腔镜下完成,无中转开腹和并发症发生。行囊肿剥除术165例,其中单侧116例,双侧47例;子宫切除加囊肿剥除术2例;附件切除术19例;子宫加双附件切除5例。术中同时行异位病灶电灼术77例,盆腔粘连分解术158例。不孕者同时行输卵管通液术。189例术后随访175例,随访率92.6%。137例痛经患者症状消失86例,减轻31例,痛经缓解率为85.4%。术后复发17例,复发率为9.7%。其中术前、后联合药物治疗140例中复发10例,复发率7.1%,未辅助药物治疗的35例中复发7例,复发率20.0%,两者相比,差异有显著性意义(P<0.05)。不孕症41人术后随访37例,妊娠17例,妊娠率45.9%。结论:腹腔镜手术治疗卵巢子宫内膜异位囊肿创伤小,安全、有效,可重复应用。术前、后辅助药物治疗可能预防术后复发。

Laparoscopic surgery for the treatment of endometrial cyst of the ovary

Objective:To evaluate the effectiveness and safety of laparoscopic surgery for the treatment of endometrial cyst of the ovary.Methods:One hundred and eighty nine patients with endometriosis staged R-AFSⅡ-Ⅳ who underwent laparoscopic surgery in Gynecologic Ward of Beijing University First Hospital from May,2003 to Dec,2004 were analyzed retrospectively.Results:Laparoscopic surgery was performed in all the patients with no conversion and complications.Of all patients,165 were treated by cystectomy with unilateral in 116 cases and bilateral in 47 ones.Two were treated by cystectomy and hysterectomy.Nineteen were treated by salpingo-oophorectomy.Salpingo-oophorectomy and hysterectomy were performed in 5 cases.During the operation,adhesion separation was done in 158 cases.Hydrotubation with blue dye were done to infertile patients during the surgery.Followed up data were available in 175(92.6%) after surgery.Of 137 patients with dysmenorrhea,the pain relieved completely in 86 and improved in 31 with a total relief rate of 85.4%.Endometriosis recurred in 17 patients.Among them,10(7.1%) were treated with additional drugs pri-and post-operation,7(20.0%) not treated with additional drugs,the differences was significant between the two groups(P<0.05).Seventeen patients conceived out of 37 cases who desire to have children.Conclusion:Laparoscopic surgery for the treatment of ovarian endometrial cysts is minimally invasive,effective,safe and can be used repeatedly.Pri-and post-operation additional drugs therapy seems to prevent the recurrence of endometriosis.