子宫肌腺病保守手术的临床分析

Clinical Observation of Conservative Surgery for Adenomyosis

目的 探讨子宫肌腺病保守手术在改善症状、增加妊娠几率方面的效果。方法 为 2 6例有生育要求的子宫肌腺病患者施行子宫肌腺瘤剔除术或子宫肌腺病部分病灶切除术。患者平均年龄 35 .8岁 ,以痛经、经血过多为主要症状。已婚患者中 ,原发不孕 7例 ( 31 .8% ) ,继发不孕 1 0例 ( 45 .5 % ) ,习惯性流产 3例 ( 1 3.6 % )。结果 子宫肌腺瘤组 1 0例 ,病灶均挖除干净。弥漫性子宫肌腺病组 1 6例 ,均仅作大部病灶切除 ,未能切净。术前 2 2例有痛经的患者 ,术后痛经消失或明显减轻 ,术后重度痛经发生率明显低于术前 ( P<0 .0 0 1 )。术前 1 7例经血过多患者 ,术后仅 4例仍有经血过多症状 ( P<0 .0 0 1 )。术后子宫肌腺瘤组 7例有生育要求的患者中 5例共妊娠 9次 ,5次足月生产 ;弥漫性子宫肌腺病组 1 4例有生育要求的患者中 3例妊娠 3次 ,1例足月生产 ,子宫肌腺瘤组术后妊娠及足月生产率明显高于弥漫性子宫肌腺病组 ( P=0 .0 3,P=0 .0 2 )。2 6例患者中 3例复发 ,平均复发时间 49.6个月。结论 子宫肌腺瘤保守手术可以明显地改善症状、增加妊娠几率 ,故能够被年轻、有生育要求的患者所接受。弥漫性子宫肌腺病保守手术妊娠率较低 ,然仍有一定的治疗价值。

Objective To study the clinical value of conservative surgery for adenomyosis in reduc- ing symptoms and raising pregnancy rate. Methods 2 6 women with histologically proven adenomyosis who wanted to preserve their reproductive capacity had conservative surgery ( adenomyomectomy or remove part lesion) .The patient′s average age was35 .8years.The main complainant were dysmenorrhea and hypermenorrhea. Of the 2 2 married patients,7 had primary infertility( 31 .8% ) ,1 0 had secondary infertility( 45 .5 % ) and3had habitual abortion ( 1 3.6 % ) .Results 1 0 patients had adenomyoma,the lesion were completely re- moved.Sixteen patients had adenomyosis,the part of lesion were removed.The rate of the severe dysmenorrhea and hypermenorrhea after operation were significantly lower than that before ( P<0 .0 0 1 ) . After operation,7patients with adenomyoma wanted to have a baby,5 patients conceived,of the total9pregnancies,5 ended in term pregnancy;1 4patients with diffuse adenomyosis wanted to have a baby,3patients had3pregnancies.One of which end- ed in term pregnancy. The rate of pregnancy and term delivery in adenomyoma patients were significantly higher than that of adenomyosis patients( P=0 .0 3,P=0 .0 0 2 ) .Among2 6 pa- tients,3relapsed.The average relapse time was49.6 months.Conclusions The conserva- tive surgery for adenomyoma can reduce symptom and raise pregnancy rate significantly,it can be accepted by young women who want to preserve their reproductive capacity.Though the pregnancy rate of conservative surgery for diffused adenomyosis was low,it still has therapeutic value.