240例卵巢子宫内膜异位症的诊断与治疗方式的探讨

240 cases study on the methods of treatment and diagnosis of ovaries endometriosis

目的:探讨卵巢子宫内膜异位症的临床特点,提高术前诊断率和探讨最佳的治疗方式。方法:回顾性分析经手术和病理确诊为卵巢内异症240例的诊治过程。结果:全部病例42.5%有痛经症状。而单纯卵巢病变75%轻度痛经,5%中度痛经,无重度痛经;合并盆腔子宫病灶的有38.68%中～重度痛经,有1.89%轻度痛经。分期Ⅰ期占3.3%,Ⅱ期24.58%,Ⅲ期62.92%,Ⅳ期9.17%。血清CA125异常率为72.5%,浓度与临床分期呈正相关。临床诊断符合率为79.6%,B超的诊断符合率为60%,术中行卵巢内异症囊肿剥离有87.1%会剥破。保守性手术中的腹腔镜手术所需的时间及出血量均短于和少于开腹手术组,差异有统计学意义,P<0.001。结论:痛经并非卵巢内异症的必见症状,痛经的有否及程度的严重性与卵巢内异症囊肿的大小无关,而与子宫及盆底病灶浸润的程度有关。术前辅助B超+CA125可帮助诊断,而确诊有赖于手术或腹腔镜检查,手术治疗是卵巢内异症的主要手段,镜下操作以视野清晰、粘连松解彻底、时间短、出血少为优势。术中宜穿刺吸收囊内巧克力液后再行囊壁剥除以减少盆腹腔污染。

Objective:To study clinical features,best ways of treatment on ovaries endometriosis, and to improve their confirmed diagnosis rate before operation.Methods:Retrospectively surveyed the course of 240 cases’ diagnosis and treatment on ovaries endometriosis,confirmed by operation and pathology.Results:42.5% of all patients have dysmenorrhoea.The mild,moderate and severe dysmenorrhoea were 7.5%, 5%,0% in simple ovary involved group,and 1.89%,38.68%,in pelvic uterus involved group respectively.The stage Ⅰ is 3.3%, stage Ⅱ 24.58%,stageⅢ 62.92%,and srage Ⅳ 9.17%.Abnormal of serum CA_ 125 were 72.5%,its title was positive related to clinical stage.The coincidence rate of clinical diagnosis was 79.6%,and that of B-ultrasonic diagnosis was 60%.Cyst broken rate is 87.1% during ovary cystectomy.The operation time and bleeding dosage in laparoscopy were less than that in laparotomy(P<0.001 ).Conclusion:Dysmenorrhoea is not essential symptoms to ovaries endometriosis.The symptom is not related to size of the cyst,but associated with the infiltrated degree of the focus of pulvic and utterus.Assisted preoperative B-ultrasonography and CA_ 125 test can help to the diagnosis of ovaries endometriosis depending on operation or laparoscopy. Operation is the main method of ovaries endometriosis. Laparoscopy has many advantages such as clear visual field,thoroughly relax,less time, less bleeding. During operation puncturing and absorbing chocolate liquid in cyst may decrease the contamination of pelvic-abdominal before cyst-wall stripping.