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目的分析腹腔镜保守性手术治疗子宫内膜异位症(EMs)后复发相关因素,并提出预防对策。方法回顾性分析武汉大学人民医院2010年1月-2013年12月择期行腹腔镜保守性手术治疗的150例EMs患者相关资料,随访3年,根据复发与否将所有患者分为复发组与非复发组,对两组患者的年龄、临床分期等指标比较,应用单因素及多因素Logistic回归分析腹腔镜保守性手术治疗EMs后复发相关因素。结果腹腔镜保守性手术治疗EMs后3年复发43例,占28.67%;单因素分析显示:复发组患者术前痛经史、Ⅲ~Ⅳ期、宫腔操作史所占比例均明显高于未复发组,术后辅助用药率明显低于未复发组,差异有统计学意义(χ~2=9.517、6.541、6.933、11.993,P<0.05),复发组患者实际年龄、发病年龄明显小于未复发组,术前孕次、术前产次均明显大于未复发组,术后孕次小于未复发组,差异有统计学意义(t=3.715、6.377、2.316、2.164、7.665,P<0.05);多因素Logistic回归分析显示,术后复发独立危险因素包括术前痛经史、临床分期、既往宫腔操作史,保护因子包括术前孕次、术后孕次、术后辅助用药;150例患者中术后采取促性腺激素释放激素激动剂(GnRHa)治疗86例(GnRHa组),孕三烯酮治疗21例(孕三烯酮组),无辅助用药43例(手术组),用药组治疗效果优于手术组,3组比较差异有统计学意义(Z=26.956、26.230,P<0.05)。结论腹腔镜保守性手术治疗EMs后复发危险因素为术前痛经史、既往宫腔操作史等,而术前孕次、术后孕次、术后辅助用药为其保护性因素。为此减少宫腔操作,加强长期用药管理,积极助孕成功妊娠可作为预防术后复发的重要对策。
Objective To analyze the related factors of recurrence after laparoscopic conservative surgery for endometriosis (EMs) and to propose preventive measures. Methods The data of 150 cases of EMs who underwent laparoscopic conservative surgery in our hospital from January 2010 to December 2013 were retrospectively analyzed. All cases were followed up for 3 years and all patients were divided into recurrence group and non-recurrence group Relapse group, the two groups of patients age, clinical stage and other indicators were compared using single factor and multivariate Logistic regression analysis of laparoscopic conservative surgery recurrence after EMs related factors. Results 43 patients (28.67%) relapsed after conservative treatment of laparoscopic surgery 3 years after unilateral laparoscopic surgery. Univariate analysis showed that the proportion of patients with dysmenorrhea, stage Ⅲ ~ Ⅳ and intrauterine operation in the recurrence group were significantly higher than those without recurrence Group, postoperative adjuvant rate was significantly lower than the non-relapse group, the difference was statistically significant (χ ~ 2 = 9.517,6.541,6.933,11.993, P <0.05), the actual age of the recurrence group, the age of onset was significantly less than the non-recurrence group (T = 3.715,6.377,2.316,2.164,7.665, P <0.05). The average number of preoperative pregnancy and preoperative birth was significantly greater than that of the non-recurrence group, and the postoperative gestational age was less than that of the non-recurrence group Logistic regression analysis showed that the independent risk factors of postoperative recurrence included history of preoperative dysmenorrhea, clinical stage, history of previous uterine operation, protective factors including preoperative gestational age, postoperative pregnancy time and postoperative adjuvant medication; in 150 patients, After treatment with GnRHa, GnRHa was given in 86 cases (GnRHa group), Gestrinone in 21 cases (Gestrinone group), 43 cases without adjuvant (operation group). The treatment group was superior to GnRHa group In the operation group, the difference between the three groups was statistically significant (Z = 26.956, 26.230, P <0.05). Conclusions Laparoscopic conservative surgical treatment of EMs risk factors for recurrence after the history of dysmenorrhea, previous history of uterine operation, etc., and preoperative pregnancy, postoperative pregnancy time, postoperative adjuvant medication for its protective factors. To reduce the uterine cavity operation, strengthen the long-term medication management, and actively assisted pregnancy success of pregnancy can be used as an important countermeasure to prevent postoperative recurrence.