腹腔镜病灶切除术后联合药物序贯治疗子宫腺肌病的效果

The Effect of Sequential Drug Treatment on Adenomyosis After Laparoscopic Focal Resection

目的探讨腹腔镜病灶切除术后联合药物序贯治疗子宫腺肌病的效果。方法选取2015年1月~2018年12月我院收治的子宫腺肌病患者53例,予腹腔镜病灶切除术后序贯使用亮丙瑞林及优思明治疗,比较术前术后血清CA125、血红蛋白含量、痛经VAS评分、经量PBLAC评分、子宫体积,不良反应、复发情况及妊娠结局。结果53例子宫腺肌瘤患者行腹腔镜病灶切除手术均获成功,手术时间(126.51±41.40)min,术中出血量(168.42±139.61)ml,平均住院(8.00±3.50)d,肛门排气时间(3.41±2.23)d。术后3个月血清CA125低于术前,血红蛋白水平高于术前,差异有统计学意义(P<0.05)。术后6、12、24、36个月痛经VAS评分、经量PBLAC评分均低于术前、子宫体积小于术前,差异有统计学意义(P<0.05);术后6、12、24、36个月痛经VAS评分、经量PBLAC评分、子宫体积比较,差异无统计学意义(P>0.05)。患者均未出现手术及药物不良反应,未观察到复发病例。15例有生育要求者,2例术后辅助生殖受孕,其中1例单胎妊娠38+1周行剖宫产,分娩一健康婴儿,无胎盘植入。结论腹腔镜病灶切除术后联合亮丙瑞林及优思明序贯治疗子宫腺肌病患者疗效确切,可有效缓解痛经,改善月经量情况,值得临床应用。

Objective To investigate the effect of sequential drug treatment on adenomyosis after laparoscopic lesion resection.Methods 53 patients with adenomyosis treated in our hospital from January 2015 to December 2018 were treated with leuprolide and yosmin sequentially after laparoscopic lesion resection,and serum CA125 before and after surgery was compared.,Hemoglobin content,dysmenorrhea VAS score,menstrual PBLAC score,uterine volume,adverse reactions,recurrence and pregnancy outcomes.Results Laparoscopic resection of 53 patients with adenomyoma was successfully performed.The operation time was(126.51±41.40)min.The intraoperative blood loss was(168.42±139.61)ml.The average hospitalization was(8.00±3.50)d,anal exhaust time(3.41±2.23)d.The serum CA125 was lower than that before surgery and the hemoglobin level was higher than that before surgery at 3 months after operation,the difference was statistically significant(P<0.05).The dysmenorrhea VAS score and menstrual volume PBLAC scores at 6,12,24 and 36 months after surgery were lower than those before surgery,and the uterine volume was smaller than before surgery,the differences were statistically significant(P<0.05);There were no significant differences in dysmenorrhea VAS score,menstrual volume PBLAC score,and uterine volume at 6,12,24 and 36 months after surgery(P>0.05).None of the patients had surgery or adverse drug reactions,and no recurrence was observed.Fifteen patients had fertility requirements,two were assisted reproductive pregnancy,one of them had a cesarean section with a single pregnancy at 38+1 weeks,and delivered a healthy baby without placental implantation.Conclusion Sequential treatment of leuprolide and yosmin in patients with adenomyosis after laparoscopic focal resection is effective,it can effectively alleviate dysmenorrhea,improve menstrual flow,and is worthy of clinical application.