腹腔镜下子宫悬吊术辅助治疗子宫内膜异位症的疗效探讨

Laparoscopic ventrohysteropexy in the treatment of endometriosis

目的 探讨腹腔镜下子宫悬吊术 (悬吊术 )在辅助手术与药物治疗子宫内膜异位症 (内异症 )中的作用与疗效。 方法 回顾性分析腹腔镜手术治疗内异症 64例 ,其中 2 1例将子宫圆韧带悬吊固定于子宫两侧副穿孔的腹直肌前鞘上 (研究组 ) ,43例未行悬吊术 (对照组 )。 结果 术后随访 (2～ 6)年 (1)痛经完全缓解 :研究组 94.1% ,对照组 87.5 % (χ2 =7.2 3 ,P <0 .0 1)。 (2 )两组均无术后复发。 (3 )术后妊娠率 :去除其他不孕病因与原因 ,研究组 92 .9%(13 /14 ) ,对照组 77.3 % (17/2 2 ) (χ2 =8.5 9,P <0 .0 0 1)。 (4 )研究组妊娠 13例 ,无不良妊娠与分娩 ;对照组妊娠 17例中有不良妊娠 5例。 (5 ) 3 0例中 2 8例于停药 1年内妊娠 ,2例于 1～ 2年后妊娠。 结论 悬吊术不仅有助于纠正后位子宫 ,防止术后再粘连 ,缓解或减轻疼痛症状 ,而且有助于恢复盆腔解剖关系 。

Objective To study the role of laparoscopic ventrohysteropexy in the treatment of endometriosis with a retroverted uterus. Methods 64 patients with endometriosis diagnosed under laparoscopy were retrospectively analyzed.After performing conservative operative procedures for the treatment of endometriosis,21 patients underwent ventrohysteropexy(group Ⅰ) and 43 patients didn't(groupⅡ). Results Follow-up study of the 64 cases for 2 to 6 years showed that (1)The complete relief rate of dysmenorrhoea was 94.1% and 87.5% in group Ⅰ and group Ⅱ,respectively.There was significant difference( χ 2=7.23, P <0.01);(2)there were no postoperative relapse in the two groups;(3)overall pregnancy rate was 46.9%(30/64).11 cases(63.3%)had stage Ⅰ,Ⅱ lesions,19 cases(63.3%)had stage Ⅲ,Ⅳ lesions among 30 pregnancies.After excluding divorce,unmarried,contraception and other causes of disease,corrective overall pregnancy rate was 83.3%(30/60),92.9%(13/14) in group I,77.3%(17/22) in group Ⅱ.There was significant difference( χ 2=8.59, P <0.01);(4)there was no unhealthy pregnancy in 13 cases of group Ⅰ,4 abortions with other causes and 1 fallopian tube pregnancy in 17 cases in group Ⅱ;(5)among 30 pregnancies,28 patients became pregnant in 1 year after stopping drug treatment. Conclusions Laparoscopic ventrohysteropexy can not only correct retroverted uterus and help to restore the normal pelvic anatomic relationship to prevent pelvic adhesion from post operation,but also relieve dymenorrhoea symptom and raise postoperative pregnancy rate.