腹腔镜联合孕三烯酮治疗子宫内膜异位症

Laparoscopy with gestrinone in the treatment of endometriosis

目的探讨腹腔镜手术联合孕三烯酮治疗子宫内膜异位症的应用价值。方法对85例子宫内膜异位症施行腹腔镜下盆腔粘连松解术、输卵管伞部造口术、巧克力囊肿剥除术及盆腔异位病灶电凝术。与同期条件相当的56例剖腹手术进行比较。结果腹腔镜手术组术中出血量、肛门排气时间、术后病率、术后平均住院日、术后恢复时间分别为（66±9）ml、（22±5）h、17．1％、（3．3±1．1）d、（10．1±2．9）d，与剖腹手术组比较差异有统计学意义（P〈0．01）。腹腔镜组术后无一例用镇痛药，术后6h拔除尿管、进食及下床活动，术后随访6个月～3年，腹腔镜组及腹剖组手术疼痛缓解有效率、月经异常恢复正常率、术后妊娠率、内异症复发率分别为100％、100％，64．29％、62．50％，65．12％、61．54％，3．53％、3．57％。结论腹腔镜下行子宫内膜异位症手术安全、有效，术后辅以孕三烯酮治疗能有效控制临床症状，延迟病灶复发时间，降低复发率，提高妊娠率。

Objective To investigate the effects on patients with endometriosis treated with laparoscopic procedure combined with gestrinone. Methods 85 patients with endometriosis were treated with lysis of pelvic cavity adhesions, salpingostomy, removing of ovarian cysts and electroeauterizafion of pelvic endometriotic tissue under the laparoscopy. The data were compared with that of 56 patients whose endometriosis were treated with laparotomy simuhaneously. Results In laparoscopy group, the amount of intraoperation bleeding, time of gas passage by anus, postoperative morbidity, average days stayed in hospital and recovery time were （ 66 ±9 ） ml, （ 22 ±5 ） h, 17.1%, （ 3.3 ±1.1 ） d and （ 10. 1 ±2.9） d respectively. There was a significant difference in laparoseopy group from in laparotomy group （ P 〈 0.01 ）. No patient needed any paregoric in laparoscopy group. The urinary catheters were removed and all patients began diet and movement off bed 6 hours after operation. All patients were followed up 0.5 - 3 years. Pain relief rate, normal catamenia recovery rate, postoperative pregnance rate and relapse rate in laparoscopy group and laparotomy group were 100% vs. 100 %, 64.29% vs. 62.50%, 65.12% vs. 61.54% and 3.53% vs. 3. 57% respectively. Conclusion The treatment of patients with endometriosis by laparoscopy is safe and efficacious. Combined with ggstrinone postoperatively, it can elfectively control symptoms, delay relapse, decrease rate and increase pregnance rate.