腹腔镜子宫骶神经切断术治疗子宫内膜异位症疼痛的多中心前瞻性对照研究

目的:研究、评价腹腔镜子宫骶神经切断术(LUNA)治疗子宫内膜异位症疼痛的安全性和有效性。方法:应用多中心随机对照的前瞻性研究方法,收集82例中、重度痛经患者的临床资料,分析比较同时行LUNA对子宫内膜异位症保守手术后各种疼痛缓解率的影响,并评价手术的安全性。结果:71例患者纳入分析,LUNA组51例,对照组20例。LUNA组术后痛经缓解率90.2%,高于对照组的60.0%(P=0.02);LUNA组性交痛术后缓解率85.7%,高于对照组的50.0%(P=0.048);LUNA组慢性盆腔痛(CPP)缓解率100%,高于对照组的71.4%(P=0.041),差异均有统计学意义。手术安全性:LUNA组患者手术时间延长,术后肛门排气时间延长,但两组术中出血量、术后体温、住院时间、总住院费用以及手术费用均无统计学差异。所有研究对象均无手术并发症发生。结论:内异症保守手术同时行LUNA手术,术后2年内能有效的缓解内异症的各种疼痛。

A multicenter prospective studies for laparoscopic uterosacral nerve ablation in the treatment of pelvic pain caused by endometriosis

Objective:To study and evaluate the safety and efficacy of laparoscopic uterosacral nerve ablation(LUNA)in the treatment of pelvic pain caused by endometriosis.Methods:A multicenter prospective study was conducted and 82 cases with laparoscopically confirmed endometriosis were enrolled in the study.We mainly assessed the pain symptom relief between patients with conservative surgery(control group)and those with conservative surgery plus LUNA(LUNA group).Results:Seventy one patients were eligible for analysis(51 in LUNA,20 in control).Significantly higher pain relief rates were observed in LUNA group than those in the control group,dysmenorrhea:90.2% for LUNA vs 60% for control,P=0.02;dyspareunia:85.7% for LUNA vs 50.0% for control,P=0.048;chronic pelvic pain:100% for LUNA vs 71.4% for control,P=0.041.Operation time and postoperative anal exhaust time prolonged in LUNA group,but as for the intraoperative blood loss,postoperative body temperature,length of hospital stay there was no significant difference.The patients of two groups all hadn't surgical complications.Conclusion:Conservative surgery plus LUNA can effectively relieve endometriosis-associated pain symptoms.