子宫腺肌瘤患者不同手术方式预后的相关分析

Prognostic correlation analysis of different surgical interventions in patients with adenomyoma of the uterus

目的探讨子宫腺肌瘤患者实施不同手术方式治疗的结局并对影响预后的相关因素进行分析。方法收集2011年1月至2019年1月于南京鼓楼医院行子宫腺肌瘤手术治疗的患者83例(实施腺肌瘤病灶挖除保守手术治疗43例和实施子宫切除术根治手术治疗40例),比较两种不同手术方式患者的预后,并采用Logistic回归分析子宫腺肌瘤患者术后复发的危险因素。结果病灶切除组的年龄、孕次、产次、月经量过多比例、子宫内膜异位症分期、术中出血量均低于子宫切除组,术后血糖类抗原125(CA125)值、复发率均高于子宫切除组,差异有统计学意义(χ^(2)/t值介于2.429~27.846之间,P<0.05);在83例手术中,术后复发22例,均发生于病灶切除组;复发组的孕次、产次、术后CA125值、腺肌瘤直径、子宫内膜异位症分期、术中出血量、手术时间均高于非复发组,差异有统计学意义(χ^(2)/t值介于1.991~4.982之间,P<0.05);Logistic回归分析结果显示较高的孕次、产次、术后CA125值、子宫内膜异位症分期、术中出血量、手术时间均是复发的危险因素,其OR值分别为5.525、3.611、1.165、7.437、1.011、1.020,P<0.05。结论对于无生育要求、年龄大于40岁、药物治疗失败的子宫腺肌瘤患者,手术方式首选病灶切除术辅助药物治疗,对于难以接受术后复发及长期用药随访的上述子宫腺肌瘤患者可考虑直接行子宫切除术;子宫腺肌瘤患者病灶切除术后高CA125值、术中子宫内膜异位症分期4期及手术困难程度是影响术后复发的危险因素。

Objective To explore the outcome of different surgical treatment methods in patients with adenomyoma of uterus,and to analyze the related factors affecting the prognosis.Methods From January 2011 to January 2019,83 patients who underwent adenomyoma surgery in Nanjing Drum Tower Hospital were collected,including 43 patients undergone resection of adenomyoma,and the other 40 patients undergone hysterectomy.The prognosis of patients with two different surgical methods was compared,and the risk factors of postoperative recurrence in patients with adenomyoma were analyzed by Logistic regression.Results The age,gestation,delivery,menorrhagia ratio,endometriosis stage and intraoperative blood loss were significantly lower in the lesion resection group than those in the hysterectomy group,while carbohydrate antigen 125(CA125)and recurrence rates were higher.The differences were statistically significant(χ^(2)/t values were between 2.429 and 27.846,P<0.05).In 83 cases,22 cases had recurrence,all of which were in the lesion resection group.The times of gestation and delivery,post-operation CA125 value,diameter of adenomyoma,endometriosis stage,intraoperative blood loss and operation time were significantly higher in the recurrent group than in the non-recurrent group,the difference was statistically significant(χ^(2)/t values were between 1.991 and 4.982,P<0.05).Logistic regression analysis showed that higher pregnancy times,delivery times,postoperative CA125 value,endometriosis stage,intraoperative blood loss and operation time were risk factors for recurrence.The OR values were 5.525,3.611,1.165,7.437,1.011,and 1.020,respectively,P<0.05.Conclusion Resection of adenomyoma with adjunctive drug therapy is the preferred surgical method for patients with adenomyoma who have no fertility requirements and are older than 40 years old and have failed drug therapy.The hysterectomy is recommended for these patients who cannot accept recurrence and long-term follow-up.High CA125 value,endometriosis stage(Ⅳstage)and difficulty of operation in patients with adenomyoma after resection are all risks for postoperative recurrence.