子宫腺肌病行子宫次全切除和子宫全切两种术式的临床比较

Clinical comparison between total hysterectomy and subtotal hysterectomy in treatment of adenomyosis

目的探讨子宫次全切术和子宫全切两种手术对子宫腺肌病术后腹痛等情况的影响。方法根据患者主诉及手术方式分为4组,分别为A1组(痛经难以忍受者行子宫全切术)、A2组(痛经难以忍受者行子宫次全切术)、B1组(月经量多无痛经者行子宫全切术)、B2组(月经量多无痛经者行子宫次全切术)。比较4组术后腹痛症状缓解率、复发率及卵巢功能,性生活满意度性及膀胱功能。结果 A1组和A2组术后痛经完全缓解率比较无显著性差异(x^2=0.102,P>0.05),但A1组患者术后慢性盆腔疼痛发病率显著高于A2组患者(x^2=6.824,P<0.05)。B1组患者术后慢性盆腔疼痛发病率显著高于B2组患者(x^2=6.623,P<0.05),A1组和B1组比较、A2组和B2组比较患者术后慢性盆腔疼痛发病率均无显著性差异(x^2值分别为1.427、1.379,均P>0.05)。A1组患者术后性生活满意度显著低于A2组,且B1组患者术后性生活满意度显著低于B2组(x^2值分别为7.832、9.315,均P<0.05),但A1组和B1组比较、A2组和B2组比较患者术后性生活满意度均无显著性差异(x^2值分别为2.367、1.652,均P>0.05)。A组与B组患者术后膀胱功能比较,膀胱尿道症状改善明显,组内和组间比较均无统计学差异(x^2值分别为1.532、1.726、1.579、1.643均P>0.05)。A组和B组术后各组内血卵泡刺激素(FSH)和雌二醇(E_2)比较无显著性差异(t值为1.084~1.621,均P>0.05)。结论子宫次全切除治疗子宫腺肌病较行子宫全切有术后性生活满意度高、慢性盆腔痛发生率低的优点。

Objective To investigate the influence of subtotal hysterectomy and total hysterectomy on symptoms including abdominal pain in treatment of adenomyosis.Methods According to complaints and operation methods the cases were divided into four groups, group A1 （ total hysterectomy for patients with dysmenorrhea） , group A2 （ subtotal hysterectomy for patients with dysmenorrhea） , group B1 （ total hysterectomy for patients with menorrhagia but no dysmenorrhea） , and group B2 （ subtotal hysterectomy for patients with menorrhagia but no dysmenorrhea） .Four groups were compared in terms of pain relieving rate and recurrent rate of pelvic pain, ovarian function, satisfaction degree of sexual life and bladder function.Results Compared with group A1, pain relieving rate was not significantly different in group A2 （χ^2 =0.102,P〉0.05）, but the incidence of chronic pelvic pain was obviously lower in group A2（χ^2 =6.824,P〈0.05）. The incidence of chronic pelvic pain in group B1 was significantly higher than group B2 （χ^2 =6.623,P〈0.05） .There was no significant difference between group A1 and B1, A2 and B2 in the incidence of chronic pelvic pain （χ^2 value was 1.427 and 1.379, respectively, both P〉0.05）.The satisfaction degree of sexual life was significantly lower in group A1 than group A2, and that was lower in group B1 than group B2 （χ^2 value was 7.832 and 9.315, respectively, both P〈0.05）.There was no significant difference in sexual satisfaction degree between group A1 and group B1, group A2 and group B2 （χ^2 value was 2.367 and 1.652, respectively, both P〉0.05）.Bladder function was improved more significantly in group A than in group B, and the differences among fours groups were not statistically significant （χ^2 value was 1.532, 1.726, 1.579 and 1.643, respectively, all P 〉0.05）.The differences in FSH and E2 were not significant between group A1 and group A2, between group B1 and group B2 （t value ranged 1.084-1.621, all P〉0.05）.Conclusion Compared with total hysterectomy, subtotal hysterectomy in the treatment of adenomyosis has the advantages of high sexual life satisfaction and low incidence of chronic pelvic pain.