改良双瓣法病灶切除术在弥漫性子宫腺肌病中的应用分析

Evaluation on the Efficacy of A Double-Flap Method of Adenomyomectomy for Diffuse Uterine Adenomyosis

目的:评价改良双瓣法病灶切除术治疗弥漫性子宫腺肌病的疗效。方法:46例弥漫性子宫腺肌病应用改良双瓣法病灶切除术,对术后是否行促性腺激素释放激素激动剂(GnRHa)治疗(GnRHa治疗3个月组19例、GnRHa治疗6个月组17例、无治疗组10例)患者的月经量、血清CA125水平、痛经及子宫大小进行手术前和手术后(1、3、6、12、18个月)比较。结果:46例患者无论术后是否进行GnRHa治疗,其3组血清CA125水平、子宫大小、月经量和痛经程度与术前比较,均显著减少(P<0.001)。术后3个月及以后各随访时间点的子宫体积均显著小于其相应术后1个月的子宫体积(P<0.01)。但患者术后各随访时间点(术后1、3、6、12、18个月)的月经量、血清CA125水平及痛经的严重程度比较,差异均无统计学意义(P>0.05)。46例患者术中与术后均无严重并发症或后遗症发生。结论:双瓣法病灶切除术可能是妇女希望保留子宫能很好治疗弥漫性子宫腺肌病的一种保守性疗法。

Objective： To evaluate the efficacy of adenomyomectomy by using a double-flap method to radically excise adenomyotic tissues diffuse uterine adenomyosis. Methods： Forty-six women with diffuse u- terine adenomyosis underwent adenomyomectomy using the double-flap method followed by gonadotropin re- leasing hormone agonist （GnRHa） treatment （3-month GnRHa treated group and 6-month GnRHa treated group） or not（ non-treated group）. Serum CA 125 levels, hypermenorrhea, dysmenorrhea and uterine size were compared between before and after surgery（1,3,6,12 and 18 months）. Results： After surgery, a significant reduction of serum CAI2s levels, uterine size, hypermenorrhea and dysmenorrhea were observed in three groups whether 46 women were treated with GnRHa or not after surgery （ P 〈 0. 001 ）. The uterine size at 1-month follow up was greater than any other, month follow up（P〈0. 01 ）in three groups,but the differences did not reach statistical significance for serum CA125 levels, hypermenorrhea or dysmenorrhea （ 1,3,6,12 or 18 months after surgery）in either group（ P 〉 0.05）. No major complications or sequelae were observed in all the 46 cases. Conclusions： The double-flap method of adenomyomectomy may be a good therapeutic option for women with diffuse uterine adenomyosis who wish to avoid hysterectomy.