子宫体马蹄形切除术治疗弥漫性子宫腺肌病

Clinical effect of U - shaped excision of uterus on diffuse adenomyosis

目的探讨子宫体马蹄形切除术在治疗弥漫性子宫腺肌病方面的可行性和安全性。方法将50例弥漫性子宫腺肌病患者分为子宫体马蹄形切除术组和全子宫切除术组，每组为25例。比较两组手术情况、术后3、6以及12个月激素水平，术后6个月性生活质量、痛经强度、糖链抗原125（CAl25）水平以及马蹄形切除术组子宫体积大小。结果全子宫切除术组后3个月E2水平较术前降低，术后6个月下降最为明显．12个月以后逐渐回升，与术前水平比较，差异有统计学意义；术后6、12个月FSH和LH水平较术前增高，差异有统计学意义。两组术后6个月痛经强度、CAl25水平以及马蹄形切除组的子宫体积均较术前下降，差异有统计学意义，全子宫切除组术后性生活质量降低。结论子宫体马蹄形切除术切除病变组织，保留子宫，不影响卵巢血供，且有效治疗子宫腺肌病。在临床可行，是治疗希望保留子宫的需行手术的弥漫性子宫腺肌病患者的首选。

Objective To examine the feasibility and safety of U-shaped excision of uterus to cure diffuse adeno- myosis. Methods Fifty women who had diffuse adenomyosis were randomly divided into two groups： twenty-five women who received U-shaped excision of uterus （study group） ; twenty-five women who received traditional hysterectomy （control group）. Average blood lose, operation time, and exhaust time were compared. Serum estradiol （E2）, fi^lhcle stimulating hormone （FSH）, and luteinizing hormone （LH） were measured at 1 month before operation, and 3 month, 6 month, and 12 month after operation. Sexual life, algomenorrhea, CA125, and the volume of uterus were also compared. Result- s Average blood lose, operation time, and exhaust time had no significant difference between the two groups. Postopera- tive hormone had no significant difference compared with preoperative results in the study group. E2 was significantly differ- ent at 3 month, 6 month and 12 month postoperation compared with preoperative E2 in the control group. FSH and LH at 6 month and 12 month postoperation were significantly increased when compared with preoperative results in the control group. Algomenorrhea, CA125, and the volume of uterus at 6 month pestoperation were significantly decreased. Lower sat- isfactory sexual life at 6 month pestoperation was reported compared with preoperation in the control group. Conclusion The U-shaped excision of uterus can get rid of pathologieal tissue while preserve the uterine and the blood supply of the ovary.