腹腔镜下子宫内膜异位症术后不同处理方法的临床疗效比较

目的观察不同方法治疗子宫内膜异位症的临床疗效以及复发情况,并评价患者的生存质量。方法将210例子宫内膜异位症患者按数字表法随机分为A、B、C 3组,每组70例。A组为单纯腹腔镜手术治疗组,B组为腹腔镜手术后加用米非司酮治疗组,C组为腹腔镜手术后加用孕三烯酮组,所有病例随访1～2年,比较3组患者的症状缓解情况、复发率及不良反应发生率,并比较3组治疗前1周、治疗后3个月、治疗后6个月患者的生存质量评分。结果 B组、C组临床疗效优于A组,且术后1年内复发率低于A组,差异均有统计学意义(P<0.05),而B组与C组之间比较差异无统计学意义(P>0.05),且2组均无再次手术者。A组不同领域生存质量得分均显著低于B、C组,差异均有统计学意义(P<0.05),随着随访时间的延长、症状复发,A组患者的生存质量呈明显下降趋势。B、C组患者短期生存质量、远期生存质量比较差异均无统计学意义(P>0.05),B、C 2组内患者随着随访时间延长,生存质量呈明显升高趋势,但差异无统计学意义(P>0.05)。与C组比较B组不良反应更轻,差异有统计学意义(P<0.05)。结论腹腔镜术后加用米非司酮或孕三烯酮治疗子宫内膜异位症疗效好,且复发率较低,能明显改善患者的生存质量,而米非司酮不良反应更轻,更宜于临床推广。

Comparison the clinical effects of different method for treatment endometriosis through laparoscopic surgey

Objective To observe the different method to treat endometriosis clinical curative effect and recurrence and survival in patients with quality evaluation.Methods 210 cases of endometriosis were randomly divided into A,B,C group,group A with pure laparoscopic surgery for the treatment group,group B for laparoscopic surgery plus with mifepristone treatment group,group C for laparoscopic surgery and apply three ketene group,all cases follow up of 1 ~ 2 years,compare three groups of patients with symptoms,recurrence rate and incidence of adverse reactions,and compare three groups 1 week before treatment,after treatment for 3 months,6 months after treatment in patients with quality of life score.Results The curative effect of group B,C was better than that of group A,and postoperative recurrence rate after I year was less than group A（P0.05）,but the curative effect,recurrence rate of group B,C group alter 1 year was not statistically significant （P0.05 ）,and the two groups were not the reoperation,different field quality of life scores of A group were significantly lower than group B and C,the difference was statistically significant（P0.05）,with follow up the extension of time,symptom recurrence,the quality of life with clear downward tendency in group A.Short term survival quality,long term survival quality comparative differences were no statistical significance between B,C groups（P0.05）,patients of B,C groups has obviously increasing trend in quality of life（P0.05 ）.Group B and group C adverse reaction was more light,the difference was statistically significant（P0.05）.Conclusion Laparoscopic surgery with mifepristone or add gestrinone treatment of endometriosis has good curative effect,and the recurrence rate is low,can greatly improve the quality of life of patients,it is worth clinical promotion.And mifepristone with its adverse reaction light,the price is cheaper,more like clinical promotion.