卵巢子宫内膜样囊肿两种不同手术途径及其术后相关治疗疗效的研究

Comparison of the effect of two conservative operations and endocrine therapy afterward on endometrioid cyst

目的本文研究卵巢子宫内膜样囊肿手术后恢复情况和比较两种不同手术途径的疗效。方法分析我院2000年～2003年收治的339例卵巢子宫内膜样囊肿患者。分为A、B两组,A组为腹腔镜手术组,A组又分为保守性手术组(A1)、半根治术组(A2);B组为开腹手术组,包括保守性手术组(B1)、半根治术组(B2)、根治术组(B3),观察患者术后复发情况。术后184例患者加用药物治疗,包括GnRH-a组90例、孕三烯酮组37例、中药组42例、避孕药组11例、丹那唑组4例。随访各组卵巢子宫内膜样囊肿术后1、2、5年复发及绝经改变情况。结果①开腹保守性手术与腹腔镜保守性手术术后卵巢子宫内膜样囊肿复发率无差异(P>0.05);②术后5年累计复发率AFS临床分期Ⅳ期组比Ⅲ期组复发率要高(P<0.05);③保守性与半根治术术后复发率无差异(P>0.05);④各用药组与未用药物组术后囊肿复发率无差异,而且各用药组囊肿复发率也无明显差异(P>0.05);⑤腹腔镜手术并不比开腹手术更容易损害卵巢内分泌功能。结论卵巢子宫内膜样囊肿治疗根治术最确切,腹腔镜手术治疗卵巢内膜样囊肿是较好的选择。

Objective To compare the effect of two conservative operations and the postoperative endocrine therapy on endometrioid cyst. Methods A total of 339 patients with endometrioid cyst admitted in our hospital from 2000 to 2003 were analyzed retrospectively. They were divided into A and B groups： group A underwent laparoscopic hysterectomy plus unilateral salpingoophorectomy, or unilateral salpingoophorectomy, or cyst removal; group B accepted laparotomy hysterectomy plus bilateral salpingoophorectomy, or hysterectomy plus unilateral salpingoophorectomy, or cyst removal. After the operation, 184 accepted endocrine therapy： 90 took GnRHa, 37 gestrinone, 42 the traditional Chinese medicine, 11 contraceptive, 4 danazol. The recurrent rates of different treatment were compared. Results （1） No difference of the recurrence was found between conservative laparoscope and laparotomy operations （P〉0.05）. （2） The recurrent rate of stage IV was higher than stage Ⅲ （P〈0.05）. （3） No difference was observed between the recurrence of cyst removal and half radical operation. （4） No recurrence difference was found between the patients with endocrine therapy and without, nor among different medications. （5） The laparoseopic operation did no affect ovarian function more than laparotomy. Conclusions The conservative laparoscopic operation is a good option for the patients with endometrioid cyst. The postoperative recurrent rate is related to the grade of disease.