病灶切除术联合药物治疗子宫腺肌病89例临床分析

Clinical Analysis of Lesion Resection Surgery Combined Medical Treatment of 89 Cases of Uterine Adenomyoma

目的:比较单纯子宫腺肌病病灶切除术与病灶切除术后联合促性腺激素释放激素激动剂(GnRH-α,亮丙瑞林注射液)或口服避孕药(去氧孕烯-炔雌醇,妈富隆片)治疗子宫腺肌病的疗效。方法:收集2006年7月至2009年7月在我院行子宫腺肌病病灶切除手术89例患者的临床资料,并对其进行随访,分析手术加GnRH-α、手术加妈富隆及单纯手术3种治疗方法的疗效。结果:3组患者治疗后痛经评分及月经量都较治疗前下降,月经量下降例数百分比分别为82.1%、83.3%和55.8%。手术加GnRH-α组治疗后痛经评分明显低于手术加妈富隆组(0.93±1.30VS2.00±1.88,P=0.027),且其痛经缓解和消失比例明显高于另两组(P=0.023;P=0.019)。3组患者随访期间复发率分别为14.3%、22.2%和39.5%。复发者与无复发者相比,年龄、初潮年龄、产次、瘤体大小、瘤体位置、手术方式及治疗前月经情况比较,差异均无统计学意义(P>0.05),但腺肌瘤病灶多发患者复发率显著高于单发患者(P=0.003),且绝大部分复发患者在治疗前有痛经。结论:病灶切除手术后无论是否辅助药物治疗均能有效治疗子宫腺肌病,术后辅助GnRH-α药物治疗能更有效控制临床症状、减少疾病复发,对于经济困难或不能耐受GnRH-α药物不良反应者口服避孕药物是不错的选择。

Objective：To compare the efficacy of lesion resection surgery plus gonadotropin-releasing hormone agonist（GnRH-α） or oral contraceptives（marvelon tablets） with surgery alone in the treatment of uterine adenomyoma.Methods：Clinical data of uterine adenomyoma patients who had lesion resection surgery in our department from July 2006 to July 2009 were collected,and the efficacy of lesion resection surgery combined GnRH-α or marvelon tablets with surgery alone was analyzed.Results：After the treatments,dysmenorrhea score（VAS） and menstrual flow in the three groups were all declined.Decreased percentage of patients on menstrual flow in each group was 82.1%,83.3% and 55.8%.The VAS of surgery＋GnRH-α group after treatment was statistically lower than that of surgery＋marvelon group（0.93±1.30 VS 2.0±1.88,P=0.027）.Also,the proportion of remission and disappearance of dysmenorrhea in surgery＋GnRH-α group was higher than those in the other two groups（P=0.023;P=0.019）.The recurrence rates during follow-up were 14.3%,22.2% and 39.5% respectively.There were no significant differences in age,menarche age,parity,tumor size,tumor number,surgical method and menstruation before treatment between recurrence and no recurrence patients（P〈0.05）.But patients with multiple adenomyoma had higher recurrence rate than those with single adenomyoma（P=0.003）,and the majority of patients with relapse had dysmenorrhea before treatment.Conclusions：Lesion resection surgery with or without adjuvant medical therapy can effectively treat uterine adenomyoma.Adjuvant GnRH-α therapy is more effective in controlling symptoms and reducing disease recurrence.For patients with economic problems or those who can＇t tolerate the side effects of GnRH-α drugs,oral contraceptive pill is a good choice.