子宫体马蹄形切除术治疗弥漫性子宫腺肌病的效果

目的探讨子宫体马蹄形切除术在治疗弥漫性子宫腺肌病方面的可行性和安全性。方法将70例弥漫性子宫腺肌病病人随机分为子宫体马蹄形切除术组（研究组）和全子宫切除术组（对照组）,每组35例。比较两组术中出血量、手术时间及手术前1个月、术后6个月血清雌二醇（E2）、卵泡刺激素（FSH）以及黄体生成素（LH）水平,比较两组术前、术后6个月性生活质量、痛经强度及糖类抗原125（CA125）水平,测量研究组子宫体积大小。结果研究组手术时间、出血量与对照组比较差异无显著性（P〉0.05）。研究组手术前后E2、FSH以及LH水平比较差异无显著性（P〉0.05）;对照组手术前后E2、FSH以及LH水平比较差异有显著性（t=2.45～2.70,P〈0.05）。两组术后6个月痛经强度、CA125水平较术前下降（t=2.23～2.56,P〈0.05）;对照组术后性生活质量明显降低（t=2.36,P〈0.05）。结论子宫体马蹄形切除术切除病变组织,保留子宫,不影响卵巢血供,且有效治疗子宫腺肌病,临床上可行,是治疗希望保留子宫的需行手术的弥漫性子宫腺肌病病人的首选方法。

CLINICAL EFFECT OF U-SHAPED EXCISION FOR BODY OF UTERUS ON DIFFUSE ADENOMYOSIS

Objective To assess the feasibility and safety of U-shape excision of body of uterus in the therapy of diffuse adenomyosis. Methods Seventy patients with diffuse adenomyosis were evenly randomized to study group（U-shape-excision group） control group（complete hysterectomy）.A comparison between the two groups was done in terms of the following items： intraoperative blood loss,operation time;serum levels of estradiol（E2）,follicle stimulating hormone（FSH） and luteinizing hormone（LH） at one month before and six months after surgery;quality of sexual life before and six months after surgery,the extent of algomenorrhea,and serum levels of CA125 and the volume of the body of uterus in the study group. Results The differences between the two groups were not significant in terms of operation time and blood loss at surgery（P0.05）.In the study group,the differences between serum levels of E2,FSH and LH before and after surgery were not significant（P0.05）,while that in the control group,the differences were significant（t=2.45-2.70,P0.05）.The extent of algomenorrhea,the level of serum CA125 decreased in both groups six months postoperatively（t=2.23-2.56,P0.05）.The quality of sexual life in the control group obviously degraded after surgery（t=2.36,P0.05）. Conclusion The U-shaped excision of the body of uterus is to remove the diseased tissue and reserve the uterus with no impact on blood supply of the ovaries.This is the first choice for those with adenomyosis that needs to be treated by surgery,and wish the uterus be reserved.