保守性手术治疗子宫内膜异位症盆腔痛的疗效及相关因素分析

Correlative factors analysis and effect of pelvic pain associated with endometriosis after onservative surgery

目的探讨子宫内膜异位症（内异症）盆腔痛患者接受保守性手术治疗后的效果，并对其影响因素进行分析。方法收集2000年1月至2009年9月在首都医科大学附属北京朝阳医院接受保守性手术治疗的内异症盆腔痛患者332例，随访截止至2010年3月，随访时间为6-108个月，平均（44±26）个月，观察患者术后的疗效，并对影响疗效的因素进行分析。结果332例内异症盆腔痛患者行保守性手术后，随访期内盆腔痛缓解患者共281例（84．6％，281／332），未缓解或加重患者共51例（15．4％，51／332）。单因素分析显示，年龄、子宫直肠陷凹重建术、骶前神经切断术（PSN）、合并子宫腺肌病、术后药物治疗是影响内异症盆腔痛患者接受保守性手术治疗后疗效的因素（P〈0．05）；多因素分析显示，这些因素也是影响内异症盆腔痛患者接受保守性手术治疗后疗效的独立因素（P〈0．05），其中，年龄大、行子宫直肠陷凹重建术和PSN、术后给予药物治疗为保护性因素，而合并子宫腺肌病为危险性因素。结论保守性手术治疗内异症盆腔痛的效果显著。年龄大、行子宫直肠陷凹重建术和PSN、术后给予药物治疗是影响内异症盆腔痛患者行保守性手术的疗效的保护性因素，而合并子宫腺肌病为危险性因素。

Objective To investigate prognosis of endometriosis and to determined correlative factors of pelvic pain associated with endometriosis after conservative surgery. Methods The clinical data in patients with pelvic pain related to endometriosis and underwent surgery treatment from January 2000 to September 2009 in Beijing Chaoyang Hospital were collected and sorted, then the patients were followed up. The data were analyzed by statistical software SPSS 13.0 for windows. Results A total of 332 patients with endometriomas were underwent conservative surgery, 281 （84.6%, 281/332） cases of them relieved pelvic pain. The univariate analysis showed that the effects were signficantly with age, Douglas pouch reconstruction, postoperative medical therapy, presacral neurectomy （PSN） and combined adenomyosis （all P〈0.05）. The multivariate analysis also showed that age（OR=0.946, P〈0.01）, Douglas pouch reconstruction （OR=0.208, P〈0.01）, postoperative medical therapy （0R=0.504, P〈0.01）, PSN （0R=0.121, P〈0.05） and combined with adenomyosis （0R=2.528, P〈0.01） were also the correlative factors to prognosis. Conclusion The protective factors for prognosis of pelvic pain associated with endometriosis included age, Douglas pouch reconstruction, postoperative medical therapy and PSN, while the risk factor was combined with uterine adenomyosis.