重度子宫内膜异位症121例腹腔镜手术治疗临床评价

Efficacy of video laparoscopy in the treatment of 121 severe pelvic endometriosis

目的:评价重度子宫内膜异位症腹腔镜手术治疗的临床价值。方法:回顾性总结了121例重度子宫内膜异位症(Ⅲ期67例,Ⅳ期54例),在腹腔镜下进行诊断并完成手术的临床经验。结果:121例患者中行保留生育功能手术者77例(其中单纯囊肿剥除者46例,单附件切除者31例);保留卵巢功能手术35例;根治性手术9例。三种手术手术时间分别为15～100min、30～126min、40～120min,平均分别为61.97min、77.14min、81.11min。术中出血量分别为5～150ml,10～100ml,40～150ml,平均分别为65.78ml,59.86ml,100.56ml。均无严重并发症发生。随访92例,痛经51例中31例痛经症状消失,11例明显减轻,总有效率82.3%。有生育要求的45例中21例妊娠,妊娠率46.7%。结论:腹腔镜手术治疗重度子宫内膜异位症安全、有效、恢复快,尤其对合并不孕症患者,既可明确诊断,又可同时治疗,提高妊娠率。

Objective： To evaluate the efficacy of laparoscopy in the treatment of severe pelvic endometriosis. Methods： A total of 121 patients with endometriosis （R-AFS stage Ⅲ-Ⅳ） treated with laparoscopy were analyzed retrospectively, 67 patients are stage Ⅲ, 54 patients are stage Ⅳ. Results： All 121 patients were successfully treated by laparoscopy. The laparoscopic surgery inclucled unilateral cystectomy in 46 cases, adnexectomy in 31 cases, remaining ovaries in 35 cases, radical surgery in 9 cases. The operating time was 15-100 min, 30-126 min, 40-120 rain, mean of 61.97 min, 77.14 rain, 81.11 rain. The bleeding volume was 5-150 ml, 10-100 ml, 40-150 ml, mean of 65.78 ml, 59.86 ml, 100.56 ml. No serious complication occurred. In the 92 cases followed up, 31 out of 51 patients with dysmenorrhoea completely released from the symptoms and 11 improved, the effective rate is 82.3%. 21 out of 45 infertile patients were impregnated, the cumulative pregnancy rate was 46. 7%. Conclusions： Laparoscopic opera-tions, characterized by minimal invasion, rapid postoperative recovery and clinical efficacy, can be used in the treatment of pelvic endometriosis, especially associated with infertility.