卵巢子宫内膜异位症的手术方式及术后处理

目的:比较开腹与腹腔镜下卵巢子宫内膜异位囊肿剥除术及术后处理方法,探讨腹腔镜在子宫内膜异位症治疗中的作用。方法:回顾性分析2001年1月～2005年12月的卵巢子宫内膜异位囊肿剥除术188例,其中92例行腹腔镜手术(腔镜组),96例行开腹手术(开腹组)。术后随访12～36个月,对两组的围手术期情况、术后症状缓解、复发率及妊娠率进行比较。选择腔镜组2005年6～12月手术的56例患者,比较其术后不同处理方法的复发、妊娠结局及用药副作用情况。结果:术中出血量腔镜组为(110.5±82.8)ml,明显少于开腹组的(189.5±96.8)ml,P0.05。手术时间腔镜组为(136.5±80.4)min,与开腹组的(148.5±86.8)min相近,P0.05。术后病率腔镜组(4.3%)明显低于开腹组(12.5%),P0.05。腔镜组术后下床活动及肛门排气时间明显缩短,P0.05。术后两组妊娠率差异有统计学意义(P0.05),复发情况差异无统计学意义(P0.05),腔镜组妊娠及复发率在不同的术后处理方法之间差异无统计学意义(P0.05)。结论:腹腔镜在子宫内膜异位囊肿治疗中具有安全、有效、微创的特点;对于有生育要求者,术者若能彻底清除盆腔内膜异位病灶,术后可不用药。

Operation modes and postoperative treatment of endometriosis of the ovary

Objective:To compare the advantages of abdominal operation and laparoscopic cystectomy of endometriosis of the ovary and treatment,explore the effect of laparoscopy in treatment of endometriosis.Methods:Among 188 patients with endometriosis of the ovary undergoing cystectomy,92 patients underwent laparoscopic cystectomy(laparoscopy group)and 96 patients underwent abdominal operation(abdominal operation group),follow-up was carried out for 12～36 months after operation,the perioperative situations,the rates of symptoms remission,recurrence and pregnancy in the two groups were compared.56 patients in laparoscopy group undergoing operation from June to December 2005 were selected,the rate of recurrence,pregnancy outcomes and adverse reactions of drugs under different treatment modes were compared.Results:The amount of blood loss during operation in laparoscopy group was(110.5±82.8)ml,which was significantly less than that in abdominal operation group (189.5±96.8)ml〕(P<0.05).The operation time of laparoscopy group was(136.5±80.4)minutes,while the operation time of abdominal operation group was(148.5±86.8)minutes,there was no significant difference(P>0.05);the postoperative morbidity of laparoscopy group(4.3%)was significantly lower than that of abdominal operation group(12.5%)(P<0.05);the postoperative activity out of bed days and anal exsufflation time in laparoscopy group were significantly shorter than those in abdominal operation group(P<0.05);there was significant difference in pregnancy rate after operation between the two groups(P<0.05),but there was no significant difference in rate of recurrence between the two groups(P>0.05);in laparoscopy group,there was no significant difference in rates of pregnancy and recurrence among different postoperative treatment modes(P>0.05).Conclusion:Laparoscopy is safe,effective,minimal-invasive in treatment of endometriosis of the ovary,for the patients with birth demand,drugs can be abandoned if complete cystectomy can be insured.