腹腔镜治疗绝经期卵巢子宫内膜异位囊肿临床分析

Laparoscopic management of postmenopausal ovarian endometrial cyst

目的评价腹腔镜手术治疗绝经期卵巢子宫内膜异位囊肿的安全性和有效性。方法回顾性分析2010年6月至2015年6月期间解放军总医院妇产科诊治并经腹腔镜手术病理证实的31例绝经后卵巢子宫内膜异位囊肿患者的临床资料。结果患者年龄平均（55.39±5.81）岁,距离绝经时间平均（5.67±5.32）年（95%CI 3.56-7.77）。4例既往有子宫内膜异位症（EMs）病史,其中3例行手术治疗。该病临床症状多不典型,就诊主诉包括发现盆腔包块29例,腹痛6例,绝经后阴道流血1例。结合妇科检查、肿瘤标志物、超声等检查可诊断。患者均行手术治疗,术中r-AFs分期：Ⅰ-Ⅱ期11例,Ⅲ-Ⅳ期20例。术后病理证实合并卵巢肿瘤7例（其中卵巢癌3例）,合并子宫腺肌症3例,合并子宫肌瘤5例。其中有26例患者得到随访,未见复发者。结论绝经期卵巢EMs患者的病灶很可能在绝经前已存在,临床表现不典型,易于漏诊;根治性手术是诊断及治疗的主要方法。

Objective To evaluate the effectiveness and safety of postmenopausal ovarian endometrial cyst. Methods From Jun. 2010 to Jun. 2015,there were 31 patients of postmenopausal ovarian endometriosis treated with laparoscopic surgery in our hospital. Clinical data were analyzed retrospectively.Results The average age was（ 55. 39 ± 5. 81） years old. The average period of menopause was（ 5. 67 ±5. 32） years（ 95% CI 3. 56-7. 77）. 4 patients had the history of EMs,with 3 patients had received surgery.Chief complaint included 29 cases of pelvic mass,6 cases of chronic pelvic pain,1 case of postmenopausal vaginal bleeding. Endometriosis were preoperatively considered in 16 cases. All patients underwent radical surgery. Stages of r-AFS were 11 cases of stage Ⅰ and Ⅱ,20 cases of stage Ⅲ and Ⅳ. The final pathologic findings of 31 cases were endometriosis with leiomyoma in 3 cases,adenomyosis in 5 cases,benign ovarian tumor in 4 cases and ovarian cancer in 3 cases. Conclusions Postmenopausal ovarian endometriosis was most likely the persistence of premenopausal endometriosis. Because its clinical picture was atypical,it was often misdiagnosed. The radical surgery was the critical methods for diagnosis and treatment.