单孔腹腔镜与多孔腹腔镜病灶切除术治疗子宫腺肌病疗效比较

Comparison of efficacy of single-port laparoscopic and multi-port laparoscopic lesion resection in patients with adenomyosis

目的探讨单孔腹腔镜与多孔腹腔镜病灶切除术治疗子宫腺肌病(AM)的疗效。方法选择2020年3月至2023年3月南阳市第一人民医院收治的80例AM患者为研究对象,根据手术方式将患者分为单孔组(n=40)和多孔组(n=40),单孔组行单孔腹腔镜病灶切除术治疗,多孔组行多孔腹腔镜病灶切除术治疗。比较2组患者术前、术后子宫体积、病灶面积、疼痛程度、月经量、糖类抗原125(CA125)水平、糖类抗原153(CA153)水平、性激素[抗米勒管激素(AMH)、雌二醇(E_(2))]指标水平及术后临床疗效。结果术前2组患者的子宫体积、病灶面积比较差异无统计学意义(P>0.05)。术后2组患者的子宫体积、病灶面积显著小于术前(P<0.05);且术后多孔组患者的子宫体积和病灶面积显著小于单孔组(P<0.05)。术前2组患者的视觉模拟评分法(VAS)评分、月经失血图(PBAC)评分比较差异无统计学意义(P>0.05)。2组患者术后的VAS、PBAC评分显著低于术前(P<0.05);术后,多孔组患者VAS评分显著高于单孔组(P<0.05),PBAC评分显著低于单孔组(P<0.05)。术前2组患者的血清CA125、CA153水平比较差异无统计学意义(P>0.05)。术后2组患者血清CA125、CA153水平显著低于术前(P<0.05),且多孔组患者的血清CA125、CA153水平显著低于单孔组(P<0.05)。术前2组患者的AMH、E_(2)水平比较差异无统计学意义(P>0.05)。术后2组患者的AMH水平显著高于术前(P<0.05),E_(2)水平显著低于术前(P<0.05);且术后多孔组患者AMH水平显著高于单孔组(P<0.05),E_(2)水平显著低于单孔组(P<0.05)。术后多孔组和单孔组患者总有效率分别为85.00%(34/40)、62.50%(25/40),多孔组患者总有效率显著高于单孔组(χ^(2)=5.230,P<0.05)。结论与单孔腹腔镜病灶切除术相比,多孔腹腔镜病灶切除术治疗AM可有效减小子宫体积、病灶面积,改善月经量及CA125、CA153、性激素水平,且疗效更优;但由于手术切口较多,术后患者疼痛程度较为严重。

Objective To investigate the efficacy of single-port laparoscopic versus multi-port laparoscopic lesion removal in patients with adenomyosis(AM).Methods Eighty patients with AM who were treated at Nanyang First People′s Hospital from March 2020 to March 2023 were selected as the research subjects and divided into single-port group(n=40)and multi-port group(n=40).The patients in the single-port group underwent single-port laparoscopic lesion resection,and the patients in the multi-port group received multi-port laparoscopic lesion resection.The uterine volume,lesion area,pain degree,menstrual blood volume,levels of carbohydrate antigen 125(CA125),carbohydrate antigen 153(CA153)and sex hormone indexes[anti-Müllerian hormone(AMH)and estradiol(E_(2))],and clinical efficacy of treatment were compared in the two groups.Results There was no statistically significant difference in the uterine volume and lesion area of patients between the two groups before treatment(P>0.05).The uterine volume and lesion area of the patients in the two groups after treatment were lower than those before treatment(P<0.05);the uterine volume and lesion area of patients in the multi-port group were significantly lower than those in the single-port group after treatment(P<0.05).The visual analogue scale(VAS)scores and pictorial blood loss assessment chart(PBAC)scores of patients in the two groups before treatment had no significant difference(P>0.05).The VAS and PBAC scores of patients in the two groups after treatment were significantly lower than those before treatment(P<0.05);the VAS scores of patients in the multi-port group were significantly higher than those in the single-port group after treatment(P<0.05),and the PBAC scores in the multi-port group were significantly lower than those in the single-port group(P<0.05).There was no statistically significant difference in the serum CA125 and CA153 levels between the two groups before treatment(P>0.05).The serum CA125 and CA153 levels of patients in the two groups after treatment were significantly lower than those before treatment(P<0.05),and the CA125 and CA153 levels of patients in the multi-port group were significantly lower than those in the single-port group after treatment(P<0.05).There was no statistically significant difference in AMH and E_(2)levels between the two groups before treatment(P>0.05).After surgery,the AMH levels of patients in the two groups were significantly higher than those before surgery(P<0.05),and the E_(2)levels were significantly lower than those before surgery(P<0.05);the AMH levels of patients in the multi-port group were significantly higher than those in the single-port group(P<0.05),and the E_(2)levels were significantly lower than those in the single-port group(P<0.05).The overall effective rate of patients in the multi-port group and the single-port group was 85.00%(34/40)and 62.50%(25/40),respectively after surgery;the overall effective rate of patients in the multi-port group was significantly higher than that in the single-port group(χ^(2)=5.230,P<0.05).Conclusion Compared with single-port laparoscopic lesion excision,multi-port laparoscopic lesion excision for AM can effectively reduce uterine volume and lesion area and improve menstrual blood volume,CA125 and CA153 levels,and sex hormone level with superior efficacy;however,due to the number of surgical incisions,the degree of pain of patients after the operation is more serious.