腹腔镜骶前神经加宫骶韧带切断术在治疗不同类型子宫内膜异位症中的应用

目的：比较和评价腹腔镜骶前神经加宫骶韧带切断术在治疗不同类型子宫内膜异位症所引起的痛经及性交痛的疗效。方法：选择2005年1月-2010年12月在本院行单纯腹腔镜子宫内膜异位症治疗者68例（A组）和同期进行腹腔镜骶前神经加宫骶韧带切断术以及内异症病灶切除75例（B组）。A组分为3个亚组：（1）腹膜型子宫内膜异位症20例（A1）行病灶切除术（;2）卵巢子宫内膜异位囊肿25例（A2）行囊肿剔除术;（3）深部浸润型子宫内膜异位症23例（A3）行病灶切除术。B组分为3个亚组：（1）腹膜型子宫内膜异位症19例（B1）;（2）卵巢子宫内膜异位囊肿29例（B2）;（3）深部浸润型子宫内膜异位症27例（B3）。对术后随访情况进行比较分析。结果：（1）A1组与B1组、A2组与B2组术后痛经及性交痛缓解率比较差异均无统计学意义（P〉0.05）;（2）A3组与B3组术后痛经及性交痛缓解率比较差异存在统计学意义（P〈0.05）。结论：腹腔镜骶前神经加宫骶韧带切断术能明显提高深部浸润型子宫内膜异位症的痛经及性交痛的治愈率。

Application of Presacral Neurectomy Combined with Uterosacral Ligament Amputation under Laparoscopic in the Treatment of Different Types of Endometriosis

Objective： To eveluate and compare the therapeutic effects of presacral neurectomy combined with uterosacral ligament amputation under laparoscopic for dysmenorrhea and sexual pain caused by endometriosis.Method： The clinic data of 143 patients with endometriosis from January 2005 to December 2010 were collected in this research.68 cases（ Group A ）were treated with hysteroscopy laparnscopy alone and the other 75 patients（ Group B ） were treated with presacral neurectomy combined with uterosacral ligament amputation under laparoscopic.Group A were divided into 3 subgoups ： （ 1 ） 20 cases （ A1 ） of peritoneal endometriosis treated with lesion resection; （ 2 ） 25 cases （ A2 ） of ovarian endometriosis treated with cyst decollement laparoscopy; （ 3 ） 23 cases （ A3 ） of deep infiltrating endometriosis. Group B were divided into 3 subgoups ： （ 1 ） 19 cases （ B 1 ） pritoneal endometriosis; （ 2 ） 29 cases （ B2 ） of varian endometriosis; （ 3 ） 27 cases （ B3 ） of deep infiltrating endometriosis.The postoperative follow-up results were compared. Result： There was no significant difference （ P〉O.O05 ）, so is it between the group A2 and that of group B2 on dysmenorrhea and sexual pain （ P〉O.05 ） . In contrast, there was significant difference of remission rate of dysmenorrhea and sexual pain between A3 and B3 （ P〈0.05 ） . Conclusion： The presacral neurectomy combined with uterosacral ligament amputation under laparoscopic can improve the cure rate of dysmenorrhea and painful sexual intercourse caused by deep invasion uterus endometriosis.