腹腔镜和开腹手术治疗卵巢子宫内膜异位囊肿的对比研究

目的：探讨腹腔镜手术治疗卵巢子宫内膜异位囊肿的临床意义。方法：回顾分析2003年7月至2008年1月124例腹腔镜卵巢子宫内膜异位囊肿剥除术和同期90例开腹卵巢子宫内膜异位囊肿剥除术的临床资料,比较两组手术时间、术中出血量、首次肛门排气时间、住院时间、术后2年内妊娠率、痛经缓解率、复发率等。结果：腹腔镜组2例中转开腹,手术成功率98.39%,术后无一例发生并发症;开腹组1例术中分离时损伤一侧输尿管,2例因肠粘连致不完全性肠梗阻,6例腹壁切口愈合不良。两组患者的年龄、手术时间、术后痛经缓解率、术后复发率差异均无统计学意义（P〉0.05）,但腹腔镜组术中出血少、术后肛门排气早、住院时间短、术后妊娠率高,差异有统计学意义（P〈0.05）。术后近期卵巢功能破坏率腹腔镜组高于开腹组,差异有统计学意义（P〈0.05）。结论：腹腔镜手术是治疗卵巢子宫内膜异位囊肿的理想术式,具有安全、微创、美观、术后康复快、妊娠率高等优点。但需掌握手术技巧,以免破坏卵巢功能。

Comparative study of laparoscopic and open surgery for ovarian endometriosis cyst

Objective:To evaluate the clinical significance of laparoscopic surgery for ovarian endometriosis cysts.Methods:The clinical data of 214 patients(124 cases in laparoscopic group,90 cases in open group) who were admitted to our department from Jul.2003 to Jan.2008 and underwent resection of ovarian endometriosis cysts were retrospectively analyzed.The operating time,intraoperative blood loss,the anal exhaust time,hospital stay,pregnancy rate in 2 years after operation,dysmenorrhea remission rate,and recurrence rate were compared between the two groups.Results:The surgical success rate in laparoscopic group was 98.39% with two cases of conversion to open surgery and no complications.There was one case of intraoperative unilateral ureteral injury,2 cases of incomplete intestinal obstruction caused by intestinal adhesion and 6 cases of poor wound healing in open group.No significant difference in age,operating time,dysmenorrhea remission rate and postoperative recurrence rate was found between the two groups(P>0.05).However,laparoscopic group was better than the open group in blood loss,anal exhaust time,hospital stay and pregnancy rate during the 2 years after operation,and the difference was significant(P<0.05).Postoperative short-term destruction rate of ovarian function in laparoscopic group was higher than in open group(P<0.05).Conclusions:Laparoscopic surgery is an ideal method for ovarian endometriosis cysts.It is safe,minimally invasive,and has advantages of better cosmesis,quick recovery and high pregnancy rate.The surgical techniques should be mastered to prevent the destruction of ovarian function.