本文選題：腹腔鏡手術(shù)　切入點(diǎn)：子宮內(nèi)膜異位癥　出處：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景子宮內(nèi)膜異位癥(endometriosis,EMS)是指有活性的子宮內(nèi)膜細(xì)胞種植在子宮內(nèi)膜以外的位置而形成的一種婦科疾病。該病的發(fā)生依賴于雌激素,因而發(fā)病常見(jiàn)于育齡期婦女,其發(fā)病癥狀主要表現(xiàn)為不孕、月經(jīng)異常、痛經(jīng)和性交疼痛,易發(fā)生復(fù)發(fā)和轉(zhuǎn)移。目前,手術(shù)治療是治療該病的首選方案,并已成為廣泛應(yīng)用的治療方案。因該病保守手術(shù)術(shù)后易復(fù)發(fā)特點(diǎn),為使殘留體內(nèi)的一些微小致病因子受到抑制、進(jìn)而萎縮甚至退化,達(dá)到延緩復(fù)發(fā)和治愈的目的,術(shù)后結(jié)合藥物治療已被廣泛應(yīng)用于臨床。目的回顧性觀察腹腔鏡手術(shù)聯(lián)合“內(nèi)異消散方”治療子宮內(nèi)膜異位癥的臨床效果,為子宮內(nèi)膜異位癥提供更好的治療方案,旨在降低患者的復(fù)發(fā)率及提高其妊娠率。研究對(duì)象與方法選取2006年1月至2016年1月于我院接受治療的子宮內(nèi)膜異位癥403例(均有迫切生育要求、手術(shù)為同一術(shù)者)進(jìn)行回顧性分析研究。按照治療方法的不同,分為對(duì)照組和觀察組,其中對(duì)照組患者采取的是腹腔鏡手術(shù)(拒絕術(shù)后應(yīng)用藥物),共200例;觀察組患者是在實(shí)施腹腔鏡手術(shù)的基礎(chǔ)上聯(lián)合內(nèi)異消散方進(jìn)行治療,共203例。觀察兩組患者的手術(shù)效果,即術(shù)后疼痛癥狀緩解率、異位癥的復(fù)發(fā)率、不孕患者的妊娠率、生化指標(biāo)CA-125情況等。采用電話或門診復(fù)診的形式進(jìn)行為期1年的隨訪,對(duì)患者的臨床資料進(jìn)行對(duì)比,分析其結(jié)果及影響因素。1.對(duì)照組平均年齡為(29.98±4.60)歲,平均不孕病史為(3.60±2.85)年,平均月經(jīng)周期為(31.09±3.55)天;觀察組平均年齡為(30.60±4.40)歲,平均不孕病史為(3.05±2.78)年,平均月經(jīng)周期為(30.12±4.56)天。兩組患者的年齡、不孕病史以及月經(jīng)周期方面的比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2.對(duì)照組手術(shù)Ⅲ期患者有127例,百分比為63.64%,手術(shù)Ⅳ期患者有73例,百分比為36.36%;觀察組患者手術(shù)Ⅲ期患者有124例,百分比為60.87%,手術(shù)Ⅳ期患者有79例,百分比為39.13%。比較兩組患者的手術(shù)分期,沒(méi)有明顯差距,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。3.對(duì)兩組患者治療前主要癥狀比較(除外非內(nèi)異癥所致),對(duì)照組下腹痛患者有100例(50.0%),性交痛患者110例(55.0%),腰骶部不適患者106例(53.0%),痛經(jīng)患者164例(82.0%),肛門墜脹感患者131例(65.2%);觀察組下腹痛患者有101例(49.8%),性交痛患者104例(51.4%),腰骶部不適患者99例(48.9%),痛經(jīng)患者170例(83.9%),肛門墜脹感患者129例(63.3%)。對(duì)兩組患者治療前主要癥狀進(jìn)行比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。結(jié)果1.對(duì)照組治療前下腹痛積分為0患者有83例,治療后患者為94例;性交痛積分為0患者有85例,治療后患者為95例;腰骶部不適積分為0患者有47例,治療后患者為77例;痛經(jīng)積分為0患者有64例,治療后患者為114例;有肛門墜脹感積分為0患者有86例,治療后患者為94例;觀察組治療前下腹痛積分為0患者有76例,治療后患者為100例;性交痛積分為0患者有78例,治療后患者為101例;腰骶部不適積分為0患者有43例,治療后患者為80例;痛經(jīng)積分為0患者有61例,治療后患者為140例;有肛門墜脹感積分為0患者有86例,治療后患者為97例,兩組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.對(duì)照組患者術(shù)后3、6、9及12個(gè)月的自然受孕率分別為25.4%,35.5%,33.1%和30.1%;輔助生殖受孕率分別為33,3%,40.%0,36.4%和35.3%;觀察組患者術(shù)后3、6、9及12個(gè)月的自然受孕率分別為38.9%,45.4%,42.2%和40.3%;輔助生殖受孕率分別為41.3%,48.9%,45.3%和42.1%。對(duì)照組和觀察組不同時(shí)期的自然受孕率和輔助生殖受孕率進(jìn)行比較,差異均有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。3.對(duì)照組手術(shù)前CA-125含量為(55.60±48.40)U/ml,術(shù)后1個(gè)月CA-125含量為35.60±28.39U/ml,術(shù)后3個(gè)月CA-125含量為(28.23±16.06)U/ml,術(shù)后12個(gè)月CA-125含量為(50.37±18.80)U/ml;觀察組手術(shù)前CA-125含量為(56.98±47.60)U/ml,術(shù)后1個(gè)月CA-125含量為(36.98±27.49)U/ml,術(shù)后3個(gè)月CA-125含量為(26.50±17.60)U/ml,術(shù)后12個(gè)月CA-125含量為(41.17±16.99)U/ml。兩組患者治療后體內(nèi)CA-125水平均下降后再上升,術(shù)前兩組CA-125水平具有可比性,術(shù)后12個(gè)月的CA-125水平進(jìn)行比較,觀察組低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。4.對(duì)照組術(shù)后3個(gè)月復(fù)發(fā)患者有5例(2.5%),術(shù)后6個(gè)月復(fù)發(fā)患者有15例(7.5%),術(shù)后1年復(fù)發(fā)患者有30例(15.0%),累積復(fù)發(fā)率為25%;觀察組術(shù)后3個(gè)月復(fù)發(fā)患者有1例(0.5%),術(shù)后6個(gè)月復(fù)發(fā)患者有2例(1.0%),術(shù)后1年復(fù)發(fā)患者有21例(10.3%),累積復(fù)發(fā)率為12%。兩組患者術(shù)后復(fù)發(fā)率均隨時(shí)間的增長(zhǎng)而升高,同期比較,觀察組復(fù)發(fā)患者少于對(duì)照組。對(duì)兩組患者患者復(fù)發(fā)情況進(jìn)行比較,差異具有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。5.患者病程(年)、有盆腔手術(shù)史、體重指數(shù)(kg/m2)、術(shù)前孕次、術(shù)前產(chǎn)次對(duì)子宮內(nèi)膜異位癥的復(fù)發(fā)情況影響不大,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)�；颊哂行g(shù)后用藥、r㧟AFS分期情況對(duì)子宮內(nèi)膜異位癥的復(fù)發(fā)情況影響較大,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論腹腔鏡手術(shù)聯(lián)合內(nèi)異消散方可以有效的緩解子宮內(nèi)膜異位癥患者的疼痛癥狀,在一定程度上控制CA-125水平升高,提高患者妊娠率,降低術(shù)后復(fù)發(fā)率。
[Abstract]:The background of endometriosis (endometriosis, EMS) refers to the cultivation of endometrial cells active in endometrial position outside a gynecological disease formed. The incidence of the disease is dependent on estrogen, so the incidence of common in women of childbearing age, the incidence of symptoms mainly show as infertility, abnormal menstruation, dysmenorrhea and sexual intercourse pain, prone to recurrence and metastasis. Currently, surgery is the preferred treatment for the treatment of the disease, and has become a widely used treatment. Because the disease conservative surgery and postoperative recurrence, in order to make some small residual in pathogenic factor is inhibited, and even atrophy degeneration, to delay the recurrence and cure objective after surgery combined with drug therapy has been widely used in clinical. Objective To retrospectively observe laparoscopic surgery combined with EM dissipation party "clinical effect in the treatment of endometriosis, uterine endometriosis In providing better treatment options, to reduce the recurrence rate and improve the pregnancy rate. 403 cases of endometriosis subjects and methods from January 2006 to January 2016 in our hospital (both urgent surgery planning requirements, for the same patient) were retrospectively analyzed. According to the different methods of treatment. Divided into control group and observation group, the patients in the control group were taken laparoscopic surgery (drug refused postoperative), a total of 200 cases; patients in the observation group is performed based on dissipation of endometriosis laparoscopic surgery on the treatment, a total of 203 cases. Observe the clinical effect of the two groups of patients, the postoperative pain the remission rate, the recurrence rate of endometriosis patients with infertility, pregnancy rate, biochemical indexes of CA-125. By telephone or outpatient department in the form of a period of 1 years of follow-up, the clinical data of the patients were compared, analysis of the The results and influencing factors of.1. control group average age (29.98 + 4.60) years old, the average for the history of infertility (3.60 + 2.85) years, the average menstrual cycle is (31.09 + 3.55) days; the observation group average age (30.60 + 4.40) years old, the average for the history of infertility (3.05 + 2.78) years, the average menstrual cycle (30.12 + 4.56) days. The two groups in age, infertility and menstrual cycle compared to the difference was not statistically significant (P0.05), with patients who were in stage III in 127 cases of.2. group, percentage of 63.64% patients with stage IV in 73 cases, accounted for 36.36%; observation in group III 124 cases, accounted for 60.87%, 79 cases of patients with stage IV, the percentage of 39.13%. of two groups were compared with surgical staging, no significant difference, the difference was not statistically significant (P0.05), comparable.3. comparison of main symptoms of patients in two groups before treatment (except non endometriosis 鎵，

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