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目的评价腹腔镜保守性手术治疗Ⅲ期和Ⅳ期子宫内膜异位症的效果,为子宫内膜异位症的治疗提供依据。方法回顾性分析腹腔镜治疗71例Ⅲ期和Ⅳ期子宫内膜异位症的手术时间、出血量、盆腔痛和痛经症状的改善、复发率及妊娠率。结果 71例患者均成功进行了腹腔镜保守手术。Ⅲ期患者手术时间(79.58±37.35)min,出血量(82.46±50.28)ml;Ⅳ期患者手术时间(177.48±45.19)min,出血量(185.88±78.64)ml,两组手术时间和出血量比较,差异均有统计学意义(P<0.01)。术后失访4例,67例患者随访2年,Ⅲ期子宫内膜异位症患者症状缓解率为82.05%(32/39),Ⅳ期患者症状缓解率为67.86%(19/28),差异无统计学意义(P>0.05)。术后2年内Ⅲ期患者复发率为10.26%(4/39),Ⅳ期患者复发率为32.14%(9/28);术后2年内Ⅲ期患者妊娠率为72.22%(13/18),Ⅳ期患者妊娠率为27.27%(3/11),两组患者复发率和妊娠率比较,差异均有统计学意义(P<0.05)。结论腹腔镜保守手术治疗Ⅲ期和Ⅳ期子宫内膜异位症能改善子宫内膜异位症相关的疼痛症状,但复发率和妊娠率与疾病期别有关。
Objective To evaluate the efficacy of laparoscopic conservative surgery in stage Ⅲ and Ⅳ endometriosis and provide evidence for the treatment of endometriosis. Methods Retrospective analysis of 71 cases of stage Ⅲ and Ⅳ endometriosis laparoscopic operation time, bleeding, pelvic pain and dysmenorrhea symptoms improved, the recurrence rate and pregnancy rate. Results All 71 patients underwent laparoscopic conservative surgery. The operative time (79.58 ± 37.35) min and the amount of bleeding (82.46 ± 50.28) ml in stage Ⅲ patients were significantly lower than those in stage Ⅲ patients (177.48 ± 45.19) min and 185.88 ± 78.64 , The differences were statistically significant (P <0.01). Four patients were lost to follow-up and 67 patients were followed up for 2 years. The rate of symptom relief was 82.05% (32/39) in stage Ⅲ endometriosis patients, 67.86% (19/28) in stage Ⅳ patients, The difference was not statistically significant (P> 0.05). The recurrence rate of stage Ⅲ was 10.26% (4/39) within 2 years after operation, and the recurrence rate was 32.14% (9/28) in stage Ⅳ. The pregnancy rate of stage Ⅲ was 72.22% (13/18) within 2 years after operation, The pregnancy rate of stage Ⅳ patients was 27.27% (3/11). There was significant difference between the two groups in recurrence rate and pregnancy rate (P <0.05). Conclusion Laparoscopic conservative surgery for stage Ⅲ and Ⅳ endometriosis can improve the pain symptoms associated with endometriosis, but the recurrence rate and pregnancy rate are related to the disease stage.