肌壁大部切除-子宫重建术联合曼月乐治疗中、重度子宫腺肌病的疗效

Efficacy of major uterine wall resection-reconstruction of the uterus combined with mirena in the treatment of moderate and severe adenomyosis

目的观察肌壁大部切除-子宫重建术(MURU)联合曼月乐(MIR)治疗中、重度子宫腺肌病(ADE)的疗效。方法选择2011年5月至2013年5月住院治疗的有保留子宫意愿的中、重度ADE患者100例作为研究对象。根据超声检测的子宫肌壁厚度及腺肌瘤的最大直径将患者分成两组,中度组52例,重度组48例。两组患者均给予MURU联合MIR治疗。对比观察两组手术时间、术中出血量,痛经评分及经量评分,治疗前后患者的血清糖类抗原125(CA125)。结果中度组患者手术时间显著短于重度组(P<0.01),术中出血量显著少于重度组(P<0.01)。治疗后两组痛经评分均降为0分,两组经量评分均显著降低(P<0.01),组间比较差异无统计学意义(P>0.05)。治疗后两组CA125值均显著下降(P<0.01)、子宫体积均显著缩小(P<0.01),治疗后重度组患者的CA125值显著高于中度组(P<0.01)。两组子宫肌壁重量比较差异无统计学意义(P>0.05)。两组患者术后及治疗期间无并发症发生。结论 MURU联合MIR治疗中、重度ADE疗效显著,具有较好的安全性,值得推广。

Objective To study the efficacy of major uterine wall resection-reconstruction of the uterus （MURU） com- bined with mirena （MIR） in the treatment of moderate and severe adenomyosis（ADE） .Methods 100 cases of moderate and severe ADE -- who admitted to our hospital from May,2011 to May,2013 and had the wish to keep their uterus -- were se- lected as the study objects.They were divided into moderate group（ 52 cases） and severe group（ 48 cases） according to uter- ine muscle wall thickness and maximum diameter of ADE displayed by ultrasonography.Both groups were treated with MURU combined with MIR.Then ,operation time ,blood loss during operation ,dysmenorrhea score ,menstrual blood volume score, ser- um carbohydrate and serum carbohydrate antigen 125 （CA125） before and after treatment were observed and compared be- tween groups.Results Operation time of the moderate group was significantly shorter than that of the severe group （P 〈 0.01 ） ,and blood loss during operation was less than that of the severe group（ P〈0.01 ）.After treatment ,dysmenorrhea scores of both groups reduced to 0, and menstrual blood volume scores all significantly decreased （P〈0.01）, no statistically signifi- cant difference was found in the comparison among groups （P〉0.05）.After treatment, values of CA 125 of both groups signifi- cantly decreased （ P〈0.01 ）, volume of uterus of both groups shrinked （ P〈0.01 ） , and value of CA125 of the severe group was significantly higher than that of the moderate group（P〈0.01 ）.Difference of weights of uterine wall of both groups was not sta- tistically significant（P〉0.05）.No complications were found in both groups during and after operation. Conclusion MURU combined with MIR has obvious therapeutic effect in the treatment of moderate and severe ADE with relatively high security. Thus, it is worthy of application and popularization in clinic.