手术治疗卵巢内膜样囊肿痛经及不孕效果分析

目的 探讨手术治疗卵巢内膜样囊肿痛经及不孕的作用及卵巢内膜样囊肿有别于其他类型子宫内膜异位症(内异症)的临床特征.方法 回顾性分析复旦大学附属妇产科医院2003年1月至2004年12月收治的850例卵巢内膜样囊肿患者的临床资料及随访结果.结果 712例完成随访(随访率83.76%).其中主诉为痛经316例(44.38%),不孕42例(5.90%),盆腔肿块294例(41.29%),痛经合并不孕60例(8.43%).术后痛经症状缓解率为87.23%(328/376).COX多因素回归分析示r-AFS分期与术后痛经症状复发相关(P＜0.05),而不同手术方式(保守性、半根治性手术)及术后是否加用促性腺激素释放激素类似物(GnRHa)治疗对痛经复发无明显影响(P＞0.05).102例合并不孕者均行保守性手术治疗,总的术后妊娠率为37.25%(38/102),其中继发不孕者高于原发不孕(53.33%对30.56%,P＜0.05).r-AFS分期与术后GnRHa治疗对术后妊娠率无影响(P＞0.05).结论 (1)对卵巢内膜样囊肿患者而言,手术治疗可缓解痛经症状,但手术方式并不能影响症状的改善,痛经复发与分期有关.(2)保守性手术可增加不孕者术后妊娠率,继发不孕者疗效优于原发不孕,术后加用GnRHa治疗并不提高术后妊娠率.

Role of surgical therapy in treating dysmenorrhea and infertility of ovarian endometrioma

Objective To explore clinical characteristics of ovarian endometrioma in particular and the effectiveness of surgical and medical therapy in treating it.Methods The medical records of 850 patients with pathologically proven ovarian endometrioma at Fudan University Hospital from 2003 to 2004 were retrospectively reviewed.Results Among 712 patients who had a follow-up,316 patients(44.38%)mainly complained of dysmenorrhea,42 patients(5.90%)of infertility,294 patients(41.29%)of pelvic mass and 60 patients(8.43%)of dysmenorrhea combined with infertility.Totally 290 out of 712 patients complained of irregular menses(40.73%).The painful symptom was relieved in 87.23% patients who complained of dysmenorrhea.R-AFS score was related to the symptom relief while the surgical mode(conservative and semi-radical surgery)and postoperative GnRHa treatment were not related to it.For all 102 infertile patients,conservative surgery was carried out.The overall post-operative pregnancy rate was 37.25%;the patients who were previously secondary infertile had a higher pregnancy rate than those who were previously primary infertile(53.33% vs 30.56%,P<0.05).The r-AFS score and post-operative GnRHa treatment were not in relation to pregnancy rate.Conclusion 1.For patients with ovarian endometrioma,painful symptoms can be relieved after surgery,and r-AFS score is related to symptom relief whereas surgical mode is not.2.Conservative surgery can improve infertility.Patients who are previously secondary infertile have a higher pregnancy rate than those who are primary infertile.However,post-operative GnRHa treatment can't improve infertility.