卵巢子宫内膜异位囊肿腹腔镜与开腹手术剥除的疗效比较

Laparoscopic Versus Open Surgery for Ovarian Endometriosis Cysts:a Comparison Study

目的比较腹腔镜下与开腹行卵巢子宫内膜异位囊肿剥除术的临床疗效。方法将276例卵巢子宫内膜异位囊肿患者根据自愿选择手术方式的原则分成2组,腹腔镜组107例,开腹组169例,比较2组临床疗效、复发率以及对卵巢功能的影响。结果腹腔镜组痛经改善率为83.9%(52/62),开腹组痛经改善率为82.7%(67/81),2组比较差异无统计学意义(P>0.05);术后1、2、5年腹腔镜组囊肿复发率分别为9.3%(8/86)、20.5%(16/78)、34.3%(23/67);开腹组复发率分别为8.5%(11/130)、24.8%(29/117)、44.4%(34/81),2组比较差异无统计学意义(P>0.05)。E2水平的比较:腹腔镜组中单纯电凝组术后1个月血清E2水平与术前比较差异无统计学意义(P>0.05);反复电凝+缝合组与开腹组术后E2水平明显低于术前(P<0.05)。结论腹腔镜卵巢子宫内膜异位囊肿剥除术与开腹手术临床疗效相似,但腹腔镜对患者损伤小,而术中过多电凝烧灼仍可能导致卵巢功能的损伤。

Objective To compare the curative effects of laparoscopic excision and open surgery on ovarian endometriotic cysts.Methods A total of 276 patients with histologically confirmed ovarian endometriotic cysts,who were admitted to our hospital between January 2003 to December 2007,were divided into laparoscopirc group（107 patients） and open group（169 patients） on a voluntary basis.The curative effects,recurrence rates and effects of surgical procedures on ovarian function were compared between the two groups.Results There were no significant differences in the remission rate of dysmenorrhea between laparoscopirc group（52/62,83.9%）and open group（67/81,82.7%）（P0.05）.In laparoscopic group,the postoperative recurrence rate in 1a,2a,5a was 9.3%（8/86）,20.5%（16/78） and 34.3%（23/67）,respectively.In open group,the recurrence rate was 8.5%（11/130）,24.8%（29/117） and 44.4%（34/81）,respectively.There were no significant differences between the two groups（P0.05）.Serum E2 was not changed obviously compared with its concentration before surgery in both groups,and there were no significant differences in E2 levels before operation and after laparoscopic operation in patients underwent simple electric coagulation（P0.05）.Compared with the preoperative level,E2 significantly decreased after operation in patients underwent laparoscopic coagulation and suture and patients underwent open surgery（P0.05）.Conclusion The curative effects of laparoscopic excision and open surgery are similar in patients with ovarian endometriotic cysts.Despite laparoscopic surgery causes little injury,too much electric coagulation may lead to damage of ovarian function during operation.