凸透镜式病灶切除术对弥漫性子宫腺肌病患者保留生育功能的影响

Effect of convex lens focal resection on fertility preservation in patients with diffuse adenomyosis

目的探讨凸透镜式病灶切除术对弥漫性子宫腺肌病患者保留生育功能的影响。方法选取2016年3月至2019年1月期间中国医科大学附属盛京医院妇产科收治的弥漫性子宫腺肌病患者84例,并分为新式手术组(行开腹凸透镜式病灶切除术)、传统手术组(行开腹U型病灶切除术)、楔形手术组(行开腹子宫楔形切除术)和子宫全切组(行开腹全子宫切除术),每组21例。比较4组患者手术时间、术中失血量、术后引流量、住院时间。比较前3组患者月经量、痛经程度、复发率和妊娠率。结果4组患者手术时间、术中出血量、术后引流量和住院时间无统计学差异。新式手术组术后月经量总缓解率和痛经总缓解率较传统手术组、楔形手术组增高,妊娠率较传统手术组明显增高,差异均有统计学意义(P<0.05)。新式手术组复发率与传统手术组、楔形手术组无统计学差异。结论凸透镜式病灶切除术并未明显增加手术时间、术中失血量、术后引流量及住院时间,却对弥漫性子宫腺肌病患者的月经量和痛经情况改善明显,术后妊娠率增高,具有临床应用价值。

Objective To investigate the effect of convex lens focal resection on fertility preservation in patients with diffuse adenomyosis.Methods We enrolled 84 patients with diffuse adenomyosis admitted to the obstetrics and gynecology department of the Shengjing Hospital of China Medical University from March 2016 to January 2019,which we divided into the new surgery(open convex lens focal resection),traditional surgery(open U-shaped lesion resection),wedge surgery(open wedge resection of the uterus),and hysterectomy groups(open hysterectomy);21 patients were included in each group.We compared the operation time,intraoperative blood loss,postoperative drainage volume,and length of hospital stay among the 4 groups.We also compared the menstrual volume,dysmenorrhea degree,recurrence rate,and pregnancy rate in the three groups.Results The operation time,intraoperative blood loss,postoperative drainage volume,and length of hospital stay did not statistically differ among the 4 groups.In the new surgery group,the total remission rates of menstrual volume and dysmenorrhea were significantly higher than those in the traditional surgery and wedge surgery groups,and the pregnancy rate was significantly higher than that in the traditional surgery group(P<0.05).Conclusion The operation time,intraoperative blood loss,postoperative drainage volume,and length of hospital stay are not significantly increased by using convex lens resection.However,the menstrual volume,dysmenorrhea and postoperative pregnancy rate improve significantly,which is of clinical value.