腹腔镜下子宫切除术治疗子宫腺肌病的临床疗效分析

Clinical Analysis of Laparoscopic Hysterectomy in the Treatment of Adenomyosis

目的探讨腹腔镜下子宫次全切除术(LSH)和子宫全切除术(LTH)治疗子宫腺肌病的临床疗效。方法选取2010年1月至2011年9月,于本院行腹腔镜下子宫切除术治疗子宫腺肌病患者200例为研究对象。按照不同手术方式,将其分为LSH组(n=100)和LTH组(n=100)。两组患者的年龄、合并症等比较,差异无统计学意义(P>0.05)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象同意,并与之签署临床研究知情同意书)。对两组患者的手术指标(手术时间、术中出血量及术后输血情况),术后短期恢复指标(术后留置导尿管时间、安置负压引流量、肛门排气时间、术后疼痛评分及住院时间),远期随访指标(术后痛经缓解状况、性生活质量评价、日常生活质量评价、盆底组织支撑情况、宫颈残端病变及恶变率,以及是否存在术后持续周期性阴道少量出血)等进行对比分析,评价LSH和LTH治疗子宫腺肌病的疗效。结果 LSH组患者手术时间、术中出血量均较LTH组明显减少,两组比较,差异有统计学意义(P<0.05);术后留置导尿管时间和住院时间亦显著缩短,两组比较,差异有统计学意义(P<0.001);而术后疼痛评分、肛门排气时间两组比较,差异无统计学意义(P>0.001);两组患者术后性生活质量及日常生活质量评价比较,差异亦无统计学意义(P>0.05)。经腹腔镜治疗后,两组患者痛经症状均有效缓解,术后并发症发生率均较低。结论 LSH治疗子宫腺肌病优于LTH。

Objective To evaluate the clinic effects of laparoscopic subtotal hysterectomy （LbH） and laparoscopic total hysterectomy （LTH） in treating adenomyosis. Methods From January 2010 to September 2011, a total of 200 cases with adenomyosis were included into this study. They were divided into two groups according to different operation methods, LSH group （n= 100） and LTH group （n = 100）. There had no significant difference on age and complications between two groups （P~ 0.05）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital. Informed consent was obtained from all participates. The following items were observed retrospectively, surgical indicators （operation duration, blood loss and postoperative blood transfusion situation）, indicators of short-term recovery （postoperative indwelling catheter time, placement of negative pressure drainage, ana indicators of long-term follow-up （a[ life quality, quality evaluation of dai exhaust time, postoperative pain score, and hospital stay）, and eviation situation of postoperative dysmenorrheal, assessment of sexual y life, pelvic floor tissue support, lesions and malignant transformation rate of cervical stump, as well as the existence of persistent postoperative cyclical vaginal bleeding）. Results The operation duration, blood loss of LSH group were less than those in LTH group, with significant difference （P% 0. 05）, the duration of urethral catheterizationn and hospital stay in LSH group were significant~.y shorter than those of LTH group, vTith significant difference （P,Q0.05）; but there were no statistic significant difference between two groups among anal exhaust time, postoperative pain score, assessment of sexual life quality, quality evaluation of daily life （P〉0. 001）. Dysmenorrhea symptoms of two groups were remission, and the incidence of postoperative complications were lower. Conclusions The clinical effects of LSH group is better than that of LTH group, and LSH is recommended in treating adenomyosis.