腹腔镜下病灶切除联合子宫动脉阻断术治疗子宫腺肌瘤的效果分析

Evaluation of laparoscopic adenomyoma combined with uterine artery occlusion in the treatment of adenomyoma

目的对腹腔镜下子宫动脉阻断术与子宫腺肌瘤病灶切除术联合治疗效果进行分析,并对子宫动脉阻断术联合应用价值进行探讨。方法2014年6月至2016年6月就诊于本院妇科的子宫腺肌病(伴子宫腺肌瘤)患者共42例,随机分配对照组和观察组各21例,对照组采用腹腔镜下子宫腺肌瘤剔除术,观察组采用腹腔镜子宫腺肌瘤剔除联合子宫动脉阻断术。比较两组患者的平均年龄、最大腺肌瘤及子宫最大径线,比较两组患者术中出血量、手术时间、术后盆腔感染率,术后12、24个月与术前的月经量比、痛经程度比、子宫体积比等。结果两组患者的年龄、最大腺肌瘤径线、子宫最大径线比较的差异均无统计学意义(P>0.05)。观察组术中出血量少于对照组,手术时间短于对照组(均P<0.05)。术后12个月,两组患者的月经量比、痛经程度比、子宫体积比比较的差异均无统计学意义(P>0.05)。术后24个月,观察组患者的月经量比为0.40±0.07,明显小于对照组(0.48±0.08)(t=3.355,P=0.02<0.05);痛经程度比为0.43±0.08,明显小于对照组0.53±0.11(t=3.199,P=0.03<0.05);而两组患者子宫体积比比较的差异无统计学意义(P>0.05)。结论子宫腺肌瘤病灶切除术可有效治疗月经量多、痛经、子宫增大等症状;联合子宫动脉阻断术减少手术出血、缩短手术时间,有助于子宫腺肌瘤病灶切除术的远期疗效。

Objective To investigate the effect and the value of laparoscopic adenomyoma combined with uterine artery occlusion in the treatment of adenomyoma.Methods From June 2014 to June 2015,42 patients with adenomyoma received surgery therapy in department of gynecology were randomly divided into control group(n=21)who received laparoscopic excision of adenomyoma and observation group(n=21)who received laparoscopic uterine artery occlusion plus excision of adenomyoma.Average age,diameter of the largest adenomyoma and length of uterine before operation were compared between two groups.The blood volume,operation time and pelvic infection rate were compared between the two groups.The rate of menstrual volume,rate of dysmenorrhea degree and rate of uterine length before resection at the 12 th month after resection and the 24 th month after resection were calculated.Results There were no significant differences about average age,diameter of the largest adenomyoma and length of uterine before operation between two groups,and the rates of menstrual volume,dysmenorrhea degree and uterine length at the 12 th month after operation compared these before resection showed no significance difference(P>0.05).The amount of bleeding in the observation group was less than that in the control group and the operation time was shorter than that in the control group.At the twenty-fourth month,the rate of menstrual volume and the rate of dysmenorrhea degree in the observation group(0.40±0.07 and 0.43±0.08)were less than those in control group(0.48±0.08 and 0.53±0.11)obviously(P<0.05),rate of uterine length between two groups showed no significance difference.Conclusion Laparoscopic adenomyoma can treat menorrhagia,dysmenorrheal and enlarged uterine.Combined uterine artery occlusion can enhance the long-term effect of laparoscopic adenomyoma.