经阴道直肠阴道隔子宫内膜异位症病灶部分切除术联合屈螺酮决雌醇长期维持治疗的效果观察

Effect observation of transvaginal partial resection plus long-term drug medication for recto-vaginal endometriosis patients

目的探析屈螺酮决雌醇长期维持和病灶部分切除术治疗经阴道直肠阴道隔子宫内膜异位症的临床效果观察。方法选取2017年3月至2018年3月湖北文理学院附属医院(襄阳市中心医院)诊治的110例经阴道直肠隔子宫内膜异位症(RVE)患者作为研究对象。110例患者均予以病灶部分切除术,根据随机对照法分组,分为观察组(n=56)和对照组(n=54),观察组服用屈螺酮决雌醇治疗,对照组术后放置左诀诺孕酮宫内缓释系统治疗,两组均治疗0.5年。另选取同期经阴道直肠阴道隔子宫内膜异位症病灶部分切除术但不愿接受药物治疗的50例患者作为空白组。应用疼痛视觉模拟评分(VAS)评估内异症相关疼痛程度;应用女性性功能指数(FSFI)评估性功能指标;应用健康调查简表(SF-36)评估健康相关生命质量,比较三组术前、术后0.5年、术后1年的内异症相关疼痛程度的视觉模拟评分(VAS);比较三组术前、术后0.5年、术后1年的女性性功能指数(FSFI);比较三组术前、术后半年、术后1年健康调查简表评分。结果三组术后0.5年、术后1年的内异症相关疼痛程度的视觉模拟评分均低于术前,但观察组术后0.5年、术后1年的大便困难、性交痛、慢性盆腔痛、痛经等内异症相关疼痛程度的视觉模拟评分与对照组、空白组相比,显著下降,差异具有统计学意义(P<0.05);三组术后0.5年、术后1年的女性性功能指数各项评分均高于术前,观察组术后0.5年、术后1年的疼痛、满意度、性高潮、阴道润滑、性唤起、性欲等女性性功能指数(FSFI)各项评分与对照组、空白组相比,显著增高,差异具有统计学意义(P<0.05);三组术后0.5年、术后1年的健康调查简表评分(SF-36)各项评分均高于术前,但观察组术后0.5年、术后1年的精神健康、躯体健康、生命活力、心理健康、社会功能、总体健康等健康调查简表评分(SF-36)与对照组、空白组相比,显著增高,差异具有统计学意义(P<0.05)。结论屈螺酮决雌醇长期维持治疗与经阴道RVE病灶部分切除术联合治疗,手术并发症风险低,可降低患者的疼痛程度,创伤小,可提高生命质量,值得临床推广。

Objective To discuss the clinical effect of transvaginal partial resection plus long-term drug medication for recto-vaginal endometriosis(RVE) patients. Methods 110 RVE patients underwent the partial resection from March 2017 to March 2018 in our hospital were selected and randomly assigned to observation group(n=56) and control group(n=54). The observation group orally took Drospirenone and Ethinylestradiol Tablets;the control group was placed with Levonorgestrel-releasing intra-uterine system. The treatment course was six months. The survey was conducted with visual analogue scale(VAS), female sexual function index(FSFI) and SF-36. The pain degree, sexual function and life quality were compared between before surgery, 6 m and 1 y after surgery using the survey results of VAS, FSFI and SF-36. Results At 6 m and 1 y postoperative, the endometriosis-associated pain degree for two groups were lower than that before surgery;the VAS scores of dyschezia, dyspareunia, chronic pelvic pain and dysmenorrhea in the observation group were significantly lower than those in the control group(P<0.05). At 6 m and 1 y after surgery, the sexual function index in the two groups were higher than those before surgery;the related scores of pain, satisfaction, orgasm, vaginal lubrication, sexual arousal and sexual desire in the observation group were significantly higher than those in the control group(P<0.05). At 6 m and 1 y after surgery, the SF-36 scores in the two groups were higher than those before surgery;the related scores of mental health, physical health, vitality, social function and general health in the observation group were significantly higher than those in the control group(P<0.05). Conclusions The long-term drug medication plus partial resection can reduce the complication rate, pain degree and clinical trauma, and improve the life quality of patients, which is worthy of clinical promotion.