腹腔镜下子宫腺肌瘤病灶挖除术的临床研究

Clinical study on laparoscopic adenomyoma with uterus gland

目的探讨腹腔镜下子宫腺肌瘤挖除术的临床特点与近期疗效。方法回顾性分析41例腹腔镜下子宫腺肌瘤病灶挖除术的临床资料、症状改善情况,讨论该术式的临床特点和近期疗效。结果 41例子宫腺肌瘤患者均行腹腔镜下病灶挖除术,无一例中转开腹,术中出血量40～100 ml(平均60 ml),术后痛经程度减轻,子宫体积缩小,术后血清CA125水平[(24.3±4.7)u/ml]下降,和术前[(78.7±6.3)u/ml]相比差异有统计学意义(P<0.05)。术后症状复发率31.5%,复发中位时间28个月。术后15例应用促性腺激素释放激素类似物(GnRH-a),与单纯手术病例相比较,两者复发率无统计学差异。结论腹腔镜下子宫腺肌瘤挖除术,对于年轻、未生育或要求保留子宫者值得应用,对于复发高危患者,术后可应用GnRH-a。熟练掌握手术技巧,特别是缝合技术,仍需要一定的训练。

Objective To investigate the effectiveness and feasibility of laparoscopic gland adenomyoma. Methods Retrospective analysis of 41 cases underwent laparoscopic adenomyoma uterine gland. Results All the patients were completed with Laparoscopic, and no patient went through the laparotomy The blood loss was about 40- 100ml （ Mid 60ml）. After surgery, the reduced degree of postoperative dysmenorrhea, uterine volume reduction and ser- um CA125 levels were significant different compared with those before surgery（ P 〈 0.05 ）. The postoperative symp- toms recurrence rate was 31.5% （median time 28 months ）. The postoperative symptoms recurrence rate underwent GnRH-a and the cases underwent surgery alone ,was not significant different between the cases （P 〉 0.05 ）. Conclu- sions Laparoscopic adenomyoma with uterine gland trauma is a efficient surgery for the people who were young, no birth or want to keep uterus. For the patients with high risk for recurrence, they can be treated by GnRH-a after sur- gery. A certain amounts of training are required for improving surgical techniques.