卵巢子宫内膜异位囊肿超声引导介入治疗与手术治疗疗效比较

Comparison of therapeutic effects for ultrasound-guided interventional sclerotherapy and surgical operation in ovarian endometriomas

目的分析与比较开腹或腹腔镜手术治疗与超声引导介入性硬化治疗卵巢子宫内膜异位囊肿的疗效及两种治疗方法的优缺点。方法将460例患者分为2组进行治疗：（1）介入组：在门诊对231例患者进行超声引导无水乙醇硬化治疗（包括手术治疗后复发41例，介入治疗后复发2例），治疗后除5例患者效仿手术后治疗加用药物治疗外，其余139例未作特殊处理；（2）手术组：在手术室对229例住院患者行开腹或腹腔镜手术治疗，术后常规药物治疗3～6个月（达菲林或诺雷德，1人用孕三烯酮）。结果介入组231例中215例（93．1％）1次治疗结束即刻超声显示囊肿消失，患者自行离开诊室；余16例中11例为双侧囊肿，每次治疗一侧共治疗2次；另5例5个囊肿因1次治疗不彻底，进行了2次治疗。介入组治疗后随访到144例患者（62．3％），失随访87例，超声显示囊肿完全消失77例，囊肿缩小、临床症状消失或减轻40例，27例囊肿复发（18．8％）；治疗后怀孕足月分娩13例。手术组229例中226例行囊肿剔除术（98．7％），卵巢切除并随之切除囊肿3例，住院3—29d（平均9．2d），术后随访到130例患者（56．8％），失随访99例。其中发生输卵管妊娠1例，11例宫内孕中孕5个月胎死宫内1例，足月分娩3例；术后囊肿复发24例（18．5％）。结论超声引导介入性硬化治疗与手术治疗均为卵巢子宫内膜异位囊肿的有效治疗方法。与手术治疗比较，介入治疗费用低，无需住院，治疗痛苦小，手术后或介入治疗后囊肿复发时可再次治疗，是卵巢子宫内膜异位囊肿有效的微创治疗方法。

Objective To compare the therapeutic effects of ultrasound-guided interventional sclero- therapy with surgical operation in ovarian endometriomas. Methods Four hundred and sixty patients were classified into two groups ： （ 1 ） interventional group ： two hundred and thirty-one patients received ultrasoundguided interventional sclerotherapy in out-patient department including 41 cases of postoperation recurrence and 2 cases of recurrence after interventional therapy. There were 5 patients also receiving medical therapy just like those after surgical operation while 139 other patients received no more treatment. （2） surgical operative group ： There were 229 patients receiving laparoseopy or laparotomy in the operation room. They also received routine postoperative medical therapy for 3 to 6 months（ mostly with Diphereline or Zoledex but 1 with gestrinone ）. Results Two hundred and fifteen patients （93.1% ） in interventional group showed complete vanishment on ultrasound examination after only one treatment and these patients left the clinic by them- selves. Among the other 16 patients, 11 with bilateral cysts received two treatments each for one cyst. The other 5 cases received two treatments owing to the incomplete vanishment of the big lesion size on the first treatment. One hundred and forty-four patients （62.3%） in this group came for follow-up, 87 cases were lost for different reasons. Seventy-seven patients showed complete disappearance of the cysts. Forty cases showed cyst shrinkage and symptoms relieved or recovered. Twenty-seven cases （ 18.8% ） had recurrence. Thirteen patients each had given birth to one baby. Two hundred and twenty-six patients in the surgical oper- ative group （98.7%） received cysteetomy and 3 received ovariotomy. They had been in hospital for 3-29 days （average 9.2 days）. Of them 130 patients were followed（56.8% ）,99 cases were lost. Twenty-four cases （18.5%） had recurrence. There were 1 tubal pregnancy and 11 intrauterine pregnancies were found after the operation including 1 death fetal and 3 term deliveries. Conclusions The surgical operation and ultrasound-guided interventional sclerotberapy were both effective in treating ovarian endometriomas. The interventional therapy which were carried out in out-patient clinic was cheap and safe compared to the surgical operation and can be reduplicated if necessary. It is a method worthy of special attention in case of disease recurrence.