病灶切除术治疗局限性子宫腺肌症的疗效及术后复发的高危因素分析

Efficacy of focal resection in the treatment of localized adenomyosis and high-risk factors for postoperative recurrence

目的 分析病灶切除术治疗局限性子宫腺肌症的疗效及术后复发的高危因素。方法 选取2017年10月至2019年10月蚌埠医学院第一附属医院收治的局限性子宫腺肌症患者120例作为研究对象,对患者进行病灶切除术,观察患者的手术时间、术中出血量、术后排气时间及术后住院时间,手术前后指标变化,复发情况及影响因素。结果 患者手术平均时间(100.70±34.00) min,术中平均出血(172.61±95.50) ml,术后平均排气时间(22.14±8.68)h,术后平均住院时间(5.02±1.01) d。与手术前相比,手术后患者子宫体积缩小、痛经评分、月经量评分降低、血红蛋白表达水平升高,血清CA125表达水平降低(P <0.05),对所有进行病灶切除术的120例患者进行随访,复发率为25.00%(30/120)。单因素分析显示,病灶切除术后复发影响因素与痛经评分、术前子宫体积、合并子宫内膜异位症相关,痛经评分较高、术前子宫体积较大、患有合并子宫内膜异位症的患者术后复发率较高,差异具有统计学意义(P <0.05)。Logistic回归分析显示,痛经评分、术前子宫体积、合并子宫内膜异位症为患者术后复发的影响因素(P <0.05)。结论 病灶切除术具有良好的治疗效果,可改善患者月经疼痛程度,并减少月经量。

Objective To analyze the efficacy of focal resection in the treatment of localized adenomyosis and the risk factors of postoperative recurrence.Methods A total of 120 patients with localized adenomyosis admitted to our hospital and underwent lesion resection from October 2017 to October 2019 were selected as the research objects.The operation time,intraoperative blood loss,postoperative exhaust time,postoperative hospital stay,indicators before and after operation,recurrence and influencing factors were observed.Results The mean operative time was(100.70±34.00) min,the mean intraoperative bleeding was(172.61 ± 95.50) ml,the mean postoperative exhaust time was(22.14 ± 8.68) hour,and the mean postoperative hospital stay was(5.02±1.01) day.Compared with those before surgery,uterine volume was reduced,dysmenorrhea score and menstrual volume score were decreased,hemoglobin expression level was increased and serum CA125 expression level was decreased after surgery(P<0.05).The recurrence rate was 25.00%(30/120) in all 120 patients.Univariate analysis showed that the influencing factors of recurrence after lesion resection were related to dysmenorrhea score,preoperative uterine volume,and complicated endometriosis.Patients with higher dysmenorrhea score,larger preoperative uterine volume,and complicated endometriosis had higher recurrence rate after surgery,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that dysmenorrhea score,preoperative uterine volume and endometriosis were the influencing factors of postoperative recurrence(P<0.05).Conclusion Excision of the lesion has a good therapeutic effect,which can improve the degree of menstrual pain and reduce menstrual volume.