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目的探讨分析子宫内膜异位症(endometriosis,EM)术后复发的相关危险因素和相关保护性因素,以期为临床提供参考,合理选择治疗方法。方法选择2003年1月—2010年4月行手术治疗的EM患者350例,搜集整理手术治疗EM患者的病历,明确患者的年龄、主诉、现病史、既往史、月经史、婚育史、个人史、家族史;妇科检查情况;B超检查、盆腔MR、血清CA125值等辅助检查;手术范围、术中情况、术后病理结果、术后恢复情况。计数资料采用χ2检验,P<0.05为差异有统计学意义。结果 26~30岁组、31~40岁组复发率(36.2%、35.0%)与≤25岁和>40岁组(13.3%、10.0%)比较差异均有统计学意义(P<0.05)。患者随着期别的增加,复发率升高,不同分期之间复发率(12.9%、37.1%、65.0%)比较差异均有统计学意义(均P<0.05)。卵巢型、腹膜型、深部浸润型、混合型复发率(22.9%、28.0%、52.2%、39.4%)组间比较差异均有统计学意义(均P<0.05),以深部浸润型复发率最高。不同手术方式复发率(37.4%、25.0%、6.7%)比较差异均有统计学意义(均P<0.05)。用药组复发率16.9%,未用药组复发率51.1%,比较差异有统计学意义(P<0.05)。结论 EM术后复发的相关危险因素为年龄、期别、手术方式及术后是否应用药物治疗药物治疗,对每位患者的治疗必须遵循个体化的治疗原则,以减少术后复发。
Objective To investigate the related risk factors and related protective factors of postoperative recurrence of endometriosis (EM), in order to provide a reference for clinical and rational treatment. Methods From January 2003 to April 2010,350 EM patients undergoing surgical treatment were enrolled. Surgical records of patients with EM were collected and analyzed. The patient’s age, chief complaint, current medical history, past history, menstrual history, history of marriage and childbirth, individual History, family history; gynecological examination; B-ultrasound, pelvic MR, serum CA125 values and other auxiliary examination; surgical range, intraoperative conditions, postoperative pathological results, postoperative recovery. Count data using χ2 test, P <0.05 for the difference was statistically significant. Results The recurrence rates (36.2%, 35.0%) between the age of 26 ~ 30 and the age group of 31 ~ 40 were significantly different from those of the patients aged ≤25 and> 40 (13.3%, 10.0%) (P <0.05). With the increase of the stage, the recurrence rate was increased. The recurrence rates (12.9%, 37.1%, 65.0%) were significantly different among different stages (all P <0.05). The recurrence rates of ovarian type, peritoneal type, deep infiltration type and mixed type (22.9%, 28.0%, 52.2%, 39.4%) were statistically significant (all P <0.05) . The recurrence rates of different surgical methods (37.4%, 25.0%, 6.7%) were significantly different (all P <0.05). The recurrence rate was 16.9% in the medication group and 51.1% in the non-medication group, the difference was statistically significant (P <0.05). Conclusion The related risk factors of recurrence after EM are age, period, operation method and whether postoperative drug treatment is applied. The treatment of each patient must follow the principle of individualized treatment to reduce postoperative recurrence.