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目的探讨子宫腺肌病合并深部浸润型子宫内膜异位症患者行U形病灶挖除术切除子宫腺肌病病灶和子宫周围深部内膜异位病灶保留子宫的可行性。方法 31例子宫腺肌病合并深部浸润型子宫内膜异位症患者,行开腹手术U形挖除子宫腺肌病病灶,缝合子宫创面后,钝性加锐性分离切除骶韧带,阴道直肠隔,输尿管周围异位病灶。比较手术前,术后1、3、6、12个月子宫体积变化和视觉模拟评分(visual analogue scale,VAS),随访观察手术效果和并发症发生情况。结果 31例均保留子宫,顺利切除子宫以外的深部内膜异位病灶;术后12个月子宫体积明显小于术前;术后12个月痛经、性交痛、肛门坠胀VAS评分(2.08±1.58、1.35±0.68、1.34±0.92)均低于术前(9.06±1.08、3.96±1.84、5.11±1.96)(P<0.05);术后12个月血清糖链抗原125水平[(16.28±6.62)u/L]低于术前[(98.26±18.65)u/L](P<0.05);术后12个月,临床症状均明显缓解,月经正常来潮,月经量较术前减少;术后发生尿潴留2例,经持续留置导尿管7~10d,排尿功能恢复;乙状结肠腹壁瘘1例,换药2个月,瘘口自行闭合;腹壁切口子宫内膜异位1例,再次手术切除异位病灶后痊愈。结论子宫腺肌病合并深部浸润型子宫内膜异位症患者行U形病灶挖除术效果确切,可保留子宫。
Objective To investigate the feasibility of uterine adenomyosis complicated with deep endometriosis in patients with adenomyosis complicated with deep infiltrative endometriosis by resection of uterine adenomyosis and deep endometriotic lesions around the uterus. Methods Thirty-one patients with adenomyosis and deep infiltrative endometriosis underwent laparotomy for U-shaped adenomyosis. After suturing the uterine wound, blunt and sharpened sacral ligaments were removed and the vaginal and rectal Every other, around the ureter ectopic lesions. The changes of uterus volume and visual analogue scale (VAS) were compared before surgery, 1,3,6 and 12 months after operation. The effect and complications of the surgery were observed. Results The uterus was preserved in all 31 cases, and the deep endometriotic lesions outside the uterus were successfully removed. The uterine volume at 12 months after operation was significantly less than that before operation. VAS score (2.08 ± 1.58) , 1.35 ± 0.68 and 1.34 ± 0.92 respectively) were lower than preoperative (9.06 ± 1.08,3.96 ± 1.84,5.11 ± 1.96) (P <0.05). The level of serum carbohydrate antigen 12 at 12 months after operation was (16.28 ± 6.62) (98.26 ± 18.65) u / L] (P <0.05). The clinical symptoms were significantly relieved at 12 months after operation, with normal menstrual cramps and decreased menstrual flow, Urinary retention in 2 cases, after continuous catheterization 7 ~ 10d, micturition function recovery; sigmoid colon abdominal fistula in 1 case, dressing 2 months, the fistula closed; abdominal incision in 1 case of endometriosis, resection After the lesion healed. Conclusion Adenomyosis complicated with deep infiltrative endometriosis patients with U-shaped lesions excavation exact results, can retain the uterus.