腹腔镜手术联合复方醋酸棉酚片治疗中重度子宫内膜异位症的临床疗效观察

目的 观察复方醋酸棉酚片辅助腹腔镜手术治疗子宫内膜异位症的临床疗效.方法 选择经腹腔镜治疗并确诊为子宫内膜异位症的患者93例,按术后用药情况随机分为A、B两组,A组48例患者于术后应用复方醋酸棉酚片6个月,B组45例患者于术后应用达菲林6个月.比较两组的疼痛缓解率、复发率及药物不良反应发生率.结果 A、B两组疼痛缓解率分别为93.75%,95.56%,复发率分别为6.25%,4.44%,不良反应发生率分别为4.17%,13.33%,两组比较差异无统计学意义.结论 复方醋酸棉酚片辅助腹腔镜治疗子宫内膜异位症安全有效,复发率低,不良反应少,且费用低廉,值得在临床推广使用.     

子宫内膜异位症致不孕的原因分析及其处理对策

目的分析子宫内膜异位症致不孕的原因,探讨相应的处理对策。方法回顾性分析2010年1月至2015年10月在我院治疗的确诊为子宫内膜异位症性不孕且有生育要求的患者97例,其中29例应用诺雷德治疗,为单用药物组;31例行腹腔镜手术治疗,为手术治疗组;37例先行腹腔镜手术,术后加用诺雷德治疗,为手术联合药物治疗组。对比各组患者治疗后的妊娠率、症状缓解率以及复发率。结果单用药物组患者治疗后的妊娠率、症状缓解率以及复发率分别为13.8%、86.2%、31.0%,手术组分别为31.0%、90.3%、19.4%,手术联合药物组分别为43.2%、100%、10.8%,对比各组差异显著,均具有统计学意义(P<0.05),由此表明,手术联合药物组的临床疗效优于单用药物组与手术组。结论子宫内膜异位症致不孕的原因是多样性的,主要包括盆腔解剖位置改变、免疫反应异常、内分泌功能紊乱等,手术联合药物治疗组的术后妊娠率、症状缓解率明显高于单用药物组及单纯手术组,且术后复发率最低。     

子宫内膜异位症保守性术后应用GnRH-a治疗对复发的影响

目的 探讨子宫内膜异位症保守性术后应用GnRH-a治疗对复发的影响.方法 选取笔者收治的腹腔镜保守性术后108例子宫内膜异位症不孕症患者,将其随机分为观察组以及对照组;对照组单纯进行手术治疗,观察组在术后予以GnRH-a治疗,比较两组治疗效果、复发率、疼痛缓解率以及不孕妊娠率.结果 观察组完全缓解率与对照组相比明显升高,复发率明显降低,P＜ 0.05.观察组术后疼痛缓解率(85.19％)明显高于对照组(62.96％),P＜0.05.其中41例不孕症患者,观察组术后2年妊娠率(64.81％)明显高于单纯手术组(31.48％),P＜ 0.05.结论 腹腔镜保守手术术后联合药物GnRH-a对中重度子宫内膜异位症进行治疗可明显降低患者术后复发率,提高术后妊娠率,值得临床上推广应用.     

单纯腹腔镜手术治疗子宫内膜异位症和腹腔镜手术联合药物治疗子宫内膜异位症的疗效比较分析

目的比较单纯腹腔镜手术治疗子宫内膜异位症和腹腔镜手术联合药物治疗子宫内膜异位症的疗效。方法对245例经腹腔镜手术和病理确诊的子宫内膜异位症患者进行回顾性分析。其中慢性盆腔痛123例,盆腔包块122例,合并不孕症14例。共有74例行单纯保守性腹腔镜手术,171例术后予口服妈富隆或孕三烯酮预防复发治疗,合并不孕症患者术后予GnRH治疗。结果术后随访1年,盆腔痛共85例术后用药者中有76例有效缓解,而不用药组38例慢性盆腔痛有26例获有效缓解(89.4% vs 68.4%,P<0.01),用药组86例盆腔包块有72例有效,而单纯手术组36例中26例有效(83.7% vs 72.2%,P<0.05),用药组171例有17例复发,而单纯手术组74例有28例复发(9.9% vs 37.8%,P<0.01)。术后1年合并不孕症患者受孕10例,受孕率71.4%。结论腹腔镜手术在腹膜型及卵巢型子宫内膜异位症患者中可取得较满意疗效,而术后用药可进一步提高疗效,降低复发率。     

盆腔子宫内膜异位症手术辅以药物治疗64例分析

目的探讨盆腔子宫内膜异位症的临床特点以及手术辅以药物治疗疗效。方法选择我院2005年1月~2009年5月收治的64例患者。结合临床症状以及术中探查情况,采取不同手术方式,术后并给予药物治疗,分析治疗效果。结果 1年后的随访发现64例患者中完全缓解率为67.2%,部分缓解率为29.7%,复发率仅为4.7%。结论根据不同临床特点采取相应手术,术后辅以药物治疗是当前治疗盆腔子宫内膜异位症比较合理的方法 。     

腹腔镜联合药物治疗子宫内膜异位症的临床分析

目的探讨腹腔镜手术联合药物治疗子宫内膜异位症的临床疗效。方法回顾性分析将我院于2011年3月至2013年3月收治的62例采用腹腔镜手术联合药物治疗子宫内膜异位症患者的临床资料,并以同期收治的66例单纯采用腹腔镜手术治疗的患者为对照组,对两组患者妊娠率以及术后腹痛、性交痛发生率进行比较,分析其差异。结果观察组术后2年的症状缓解率、妊娠率明显高于对照组,复发率低于对照组,差异均有统计学意义(P<0.05)。结论腹腔镜手术联合药物治疗子宫内膜异位症疗效良好,对提高妊娠率与症状缓解率,降低复发率具有重要意义。     

腹腔镜联合药物治疗子宫内膜异位症的效果观察

目的：观察腹腔镜手术联合药物治疗子宫内膜异位症的效果。方法：选择100例患者分为对照组和实验组,每组各50例,均在腹腔镜下行保守手术。实验组于术后口服孕三烯酮,剂量每次2.5 mg,每周2次,疗程为3个月。结果：实验组复发率显著低于对照组,疼痛缓解率明显高于对照组。结论：腹腔镜保守手术治疗后联合应用药物孕三烯酮,可有效治疗子宫内膜异位症患者,降低术后复发率,疼痛缓解率提高。     

腹腔镜联合不同药物治疗中、重型子宫内膜异位症的疗效比较

目的评价腹腔镜联合不同药物治疗中、重型子宫内膜异位症的疗效。方法 189例中、重型子宫内膜异位症合并不孕患者经腹腔镜手术治疗后分别联合应用甲羟孕酮、米非司酮、孕三烯酮、诺雷德治疗3个月,比较各组间的症状缓解率、复发率、妊娠率。结果术后两年,诺雷德组症状缓解率显著高于其他各组,复发率显著低于其他各组,妊娠率各组无明显差异。结论中、重型子宫内膜异位症腹腔镜手术后联合用药可改善疼痛症状,降低复发率;诺雷德在提高症状缓解率及降低复发率方面优于甲羟孕酮、米非司酮及孕三烯酮。     

腹腔镜联合药物治疗子宫内膜异位症的临床观察

目的探讨子宫内膜异位症腹腔镜手术后联合药物治疗的临床疗效。方法选取我院115例腹腔镜子宫内膜异位症保守手术后的患者,随机分为3组:米非司酮组35例,孕三烯酮组40例,术后未用药物者为对照组30例,定期随访,比较3组患者术后疗效、术后复发、妊娠及用药副反应等情况。结果 3组患者痛经症状均得到不同程度缓解,米非司酮组和孕三烯酮组术后缓解率、术后复发率比较差异无统计学意义(P>0.05),对照组术后完全缓解率低于其他两组(P<0.05),复发率显著高于其他两组(P<0.05),3组术后妊娠率比较差异无统计学意义(P>0.05)。结论腹腔镜术后联合米非司酮或孕三烯酮治疗子宫内膜异位症较单纯手术治疗复发率低、治疗效果可靠,但术后药物治疗未能显著提高妊娠率。     

腹腔镜联合药物治疗子宫内膜异位症的临床观察

目的 探讨子宫内膜异位症腹腔镜手术后联合药物治疗的临床疗效.方法 选取我院115例腹腔镜子宫内膜异位症保守手术后的患者,随机分为3组:米非司酮组35例,孕三烯酮组40例,术后未用药物者为对照组30例,定期随访,比较3组患者术后疗效、术后复发、妊娠及用药副反应等情况.结果 3组患者痛经症状均得到不同程度缓解,米非司酮组和孕三烯酮组术后缓解率、术后复发率比较差异无统计学意义 (P＞0.05),对照组术后完全缓解率低于其他两组 (P＜0.05),复发率显著高于其他两组 (P＜0.05),3组术后妊娠率比较差异无统计学意义(P＞0.05).结论 腹腔镜术后联合米非司酮或孕三烯酮治疗子宫内膜异位症较单纯手术治疗复发率低、治疗效果可靠,但术后药物治疗未能显著提高妊娠率.     

腹腔镜在不明原因不孕症中诊断和治疗的临床研究

目的 探讨不明原因不孕症中盆腔腹膜子宫内膜异位症的诊断以及治疗方法。方法选择323例不明原因不孕患者行腹腔镜手术，诊断盆腔腹膜子宫内膜异位症患者手术采用病灶内凝固术及腹腔冲洗方法，术后分2组观察妊娠情况：对照组为术后6个月内妊娠情况，治疗组为术后口服达那唑6个月，停药后6个月内妊娠情况，比较2组妊娠率。结果323例不明原因不孕患者中盆腔腹膜子宫内膜异位为274例占84．8％，对照组妊娠率81．4％，治疗组妊娠率为76．9％，2组比较差异无统计学意义（P〉0．05）。结论对不明原因的不孕患者应尽早行腹腔镜检查，对盆腔腹膜子宫内膜异位症采用腹腔镜下病灶内凝固术及腹腔冲洗可有效提高妊娠率，提倡术后半年内妊娠，如半年后不孕者可考虑药物治疗。     

青春期子宫内膜异位症30例临床分析

目的：探讨子宫内膜异位症青春期发病的临床特点、诊断及治疗。方法：总结分析30例青春期子宫内膜异位症患者的资料。结果：诊断内膜异位症距离初潮年龄平均间隔时间为4.5年,发病距就诊平均时间为2.3年,临床表现为盆腔包块、痛经、慢性盆腔痛、急性腹痛。30例患者均经手术治疗,其中16例（53.3%）进行了腹腔镜诊断及治疗,术前误诊18例（60.0%）,根据美国生育协会修订的子宫内膜异位症分期（R-AFS）标准,Ⅰ期4例（13.3%）,Ⅱ期5例（16.7%）,Ⅲ期13例（43.3%）,Ⅳ期8例（26.7%）,其中伴发生殖道畸形3例,占10.0%。结论：青春期子宫内膜异位症的临床主要症状为盆腔包块和痛经,手术是其主要治疗手段,术后用药可降低复发率。     

Endometriosis 1990. Current treatment approaches

Endometriosis is an extremely common gynaecological disease, affecting between 1 and 5% of women of reproductive age. Women with endometriosis typically present for medical care with one of more of the following problems: pelvic pain, infertility, or a large adnexal mass (an endometrioma). The primary treatment for an endometrioma is surgical. However, long term postoperative hormone therapy may be necessary to prevent new endometriomas from developing. There is no evidence that hormonal therapy of endometriosis will improve fecundability in women with endometriosis and infertility. Pelvic pain due to endometriosis can be successfully treated with hormonal agents in the majority of patients. Four basic hormonal regimens are currently available for the treatment of endometriosis: (a) danazol; (b) gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); gonadorelin] agonists; (c) progesterones (progestins); and (d) combined estrogens and progesterones. Randomised, controlled, clinical trials suggest that danazol and the GnRH agonists are equally effective in the treatment of endometriosis. However, the side effects caused by danazol and the GnRH agonists are markedly different. Danazol produces androgenic side effects including weight gain, hirsutism, acne, oily skin and deepening of the voice. GnRH agonists produce side effects due to hypoestrogenism, including hot flushes, osteoporosis and dry vagina. The ideal drug regimen for the treatment of endometriosis remains to be developed.     

Dienogest: a review of its use in the treatment of endometriosis

Dienogest (Visanne?) is a synthetic oral progestogen with unique pharmacological properties that is indicated at a dosage of 2?mg/day for the treatment of endometriosis. It is generally highly selective for the progesterone receptor and displays strong progestational effects and moderate antigonadotrophic effects, but no androgenic, glucocorticoid or mineralocorticoid activity. Dienogest has moderate affinity for progesterone receptors (10% that of progesterone) and at a dosage of 2?mg/day only moderately suppresses estradiol levels. It has high oral bioavailability and a half-life suitable for once-daily administration. In randomized clinical trials, oral dienogest was significantly more effective than placebo in reducing pelvic pain in patients with confirmed endometriosis. In trials comparing oral dienogest for 16 or 24 weeks with gonadotropin-releasing hormone (GnRH) agonists commonly used in the treatment of endometriosis, dienogest was noninferior to depot leuprorelin in reducing pelvic pain and was not significantly different from intranasal buserelin and depot triptorelin in improving combined symptoms/signs scores or revised American Fertility Society (rAFS) staging scores, respectively. Improvements were also noted in some measures of health-related quality of life. The efficacy of dienogest was sustained during long-term treatment for more than 1 year. Dienogest was generally well tolerated and was not considered to be associated with clinically relevant androgenic effects. It appeared to have fewer hypoestrogenic effects than the GnRH agonists. Dienogest was associated with a high incidence of abnormal menstrual bleeding patterns, although this was generally well tolerated by patients, with few discontinuing therapy, and the bleeding intensity and frequency decreased over time. Therefore, oral dienogest offers an effective, generally well tolerated therapeutic option for the long-term treatment of endometriosis.     

Treatment of endometriosis

Endometriosis is one of the frequent gynecological diseases in premenopausal women. The clinical diagnostics is difficult because symptoms of endometriosis are variable. The surgical removal of endometriosis is the primary therapeutic aim. Medical treatment plays a very important role in the therapy of this chronic disease. A symptomatic therapy by analgetics should be combined with a hormonal treatment. The use of oral contraceptives in extended cycle or long-term use is effective against endometriosis associated pain. Progestogens, especially dienogest, which is licensed for endometriosis treatment and good investigated, are very effective and also available for long-term use. GnRH-analogues are effective for a short-term treatment (duration of 3 months). The long-term treatment with GnRH-analogues should only be used in selected cases and in combination with an add back therapy. Treatment of endometriosis should be planned individually for each patient, dependent on stage, localization and activity of endometriosis and further family planning. By the combination of hormonal and operative treatment possibilities a maximum period free of pain or recurrence of endometriosis can be reached.     

腹腔镜治疗不孕症158例临床分析

目的 探讨腹腔镜对女性不孕症的诊断和治疗价值.方法 对158例不孕症妇女进行腹腔镜检查,对发现的盆腔疾病进行相应的治疗统计.结果 腹腔镜检查发现不孕症的盆腔器质性病变158例,检查阳性率为100%.其中一侧或双侧输卵管阻塞并盆腔粘连76例,占48.1%,子宫内膜异位症40例,占25.32%,多囊卵巢25例,占15.82%.原发性不孕术后妊娠率为74.07%,继发性不孕为84.38%.结论 输卵管阻塞、盆腔粘连和子宫内膜异位症是女性不孕症的主要病因.腹腔镜对诊断女性不孕症的盆腔病因以及针对性治疗有着良好的效果,值得广泛推广.     

改良保留灌肠治疗慢性盆腔炎的临床效果分析

目的探讨改良保留灌肠治疗慢性盆腔炎的效果。方法选择2012年5月-2013年12月收治的慢性盆腔炎患者120例,随机均分为对照组和观察组,对照组采用传统保留灌肠法治疗,观察组采用改良保留灌肠法治疗,观察两组的临床治疗效果,统计两组的插管成功率、管道脱出率、药物外泄率及患者肛门疼痛率。结果观察组总有效率为90．0％,对照组总有效率为75．0％,观察组总有效率明显高于对照组,差异有统计学意义（P〈0．05）：观察组1次插管成功率高于对照组,管道脱出率、药物外泄率及患者肛门疼痛率明显低于对照组,差异有统计学意义（P〈0．05）。结论改良保留灌肠治疗慢性盆腔炎效果较好,可延长药物保留时间,减少管道脱出情况及患者不适感,值得临床应用。     

A new translaparoscopic approach in endometriosis treatment: a. CO2 laser endometriosis excision and/or vaporization. b. CO2 laser uterine nerve ablation. c. Uterine suspension with Falope Rings. d. Intraperitoneally 32% Dextran-70 installation.

During a period of 18 months with a history of chronic pelvic pain symptomatology (severe dysmenorrhea, severe dyspareunia, extramenstrual pain) retroverted or retroflexed uterus, and infertility were subjected to laparoscopy for diagnostic and therapeutic purposes as well. These women were able to follow up this protocol. After informed consent had been presented patient decided, in a case of endometriosis being verified by the tissue pathology intraoperatively, which one mode of therapy (Group I or Group II) would be administered in her case. All women failed to respond to non-steroidal, antiinflammatory medication, as well as to oral contraceptive treatment. Proposed intraoperative staging of pelvic endometriosis that has not yet been published, was utilized by the author. Group I twenty women were subjected to a translaparoscopic CO2 laser excision and (or vaporization of endometriosis implants, CO2 laser uterine nerve ablation, uterine suspension with Falope Rings and intraperitoneally 32% Dextran was installed. Group II twenty women were subjected only to a translaparoscopic CO2 laser endometriosis excision and/or vaporization and intraperitoneally 32% Dextran-70 was installed. In Group I extramenstrually pain was 90%, severe dysmenorrhea 85%, and infertility 90% were cured. Ten per cent of extramenstrual pain, 5% of severe dysmenorrhea, and 15% of severe dyspareunia were improved. Infertility in this group was unchanged in 10%. Patients' symptoms were not worsened during the 18 months of observation. In Group II only 60% infertility was curred. In 60% extramenstrual pain, in 35% severe dysmenorrhea, in 5% severe dyspareunia were improved. Symptoms were noted to worsen in 5% extramenstrual pain, in 5% severe dysmenorrhea, in 10% severe dyspareunia.(ABSTRACT TRUNCATED AT 250 WORDS)