本文選題：卵巢子宮內(nèi)膜異位癥　切入點：術(shù)后復發(fā)　出處：《吉林大學》2015年碩士論文

【摘要】：目的：卵巢子宮內(nèi)膜異位癥（Ovarian endometriosis，簡稱OM）是婦科常見病及多發(fā)病，近年來其患病率明顯增高。常見癥狀主要為痛經(jīng)、性交痛和不孕。臨床治療以減滅病灶、減輕癥狀和促進生育為目的。由于卵巢子宮內(nèi)膜異位癥保守性手術(shù)術(shù)后復發(fā)率高，國內(nèi)外學者更加關(guān)注影響術(shù)后復發(fā)的相關(guān)因素。本研究通過回顧性分析，探討復發(fā)的相關(guān)因素，尋找對應的干預措施。 方法：抽取吉林大學第二醫(yī)院婦產(chǎn)科醫(yī)院2010年12月-2012年12月間因OM行保守性手術(shù)的患者377例，將隨訪發(fā)現(xiàn)復發(fā)的病例作為觀察組，未復發(fā)的病例作為對照組，進行回顧性分析。根據(jù)復發(fā)率、回歸系數(shù)等各項指標的比較，找出相關(guān)因素。 結(jié)果：1、OM保守性手術(shù)術(shù)后2年復發(fā)率為13.73%（49/357）。 2、各年齡段分組的復發(fā)率18歲組為0%（0/3）、18-45歲組為15.33%（49/322）、45歲組為0%（0/32）。既往無人流史的復發(fā)率為13.74%（29/211），1次人流史的復發(fā)率為8.25%（8/97）,2次人流史的復發(fā)率為10.34%（3/29），3次及以上人流史的復發(fā)率為45%（9/20）。手術(shù)途徑中經(jīng)腹手術(shù)組的復發(fā)率為17.78%（40/225），腹腔鏡手術(shù)組的復發(fā)率為6.82%（9/132）。術(shù)后用藥組的復發(fā)率為6.31%（7/111），，術(shù)后未用藥組的復發(fā)率為17.07%（42/246）。術(shù)后有妊娠史組的復發(fā)率為3.26%(3/92)，無妊娠史組的復發(fā)率為17.36%（46/225）。初次手術(shù)時單側(cè)發(fā)病組的復發(fā)率為9.2%（16/174），雙側(cè)發(fā)病組的復發(fā)率為18.00%（33/183）。包塊大小各組的復發(fā)率，5cm組為5.5%（3/54），5-10cm組為12.7%（26/204），10cm組為20.2%（20/99）。有痛經(jīng)組的復發(fā)率為15.88%（44/277），無痛經(jīng)組的復發(fā)率為6.25%（5/80）。合并腺肌癥組的復發(fā)率為22.34%（21/94）,未合并腺肌癥組的復發(fā)率為10.65%（28/263）。以上各變量的組內(nèi)復發(fā)率比較，P均0.05,有統(tǒng)計學意義。 3、單因素Logistic回歸分析結(jié)果：首次發(fā)病年齡、痛經(jīng)與否、人流史及次數(shù)、術(shù)后用藥與否、初次手術(shù)時單雙側(cè)、手術(shù)途徑、術(shù)后妊娠與否、包塊大小、合并腺肌病與否的wald值分別為6.049、4.866、19.258、7.488、5.883、8.439、11.462、6.865、7.997（P值均＜0.05）。 4、多因素Logistic回歸分析結(jié)果:首次發(fā)病年齡、痛經(jīng)與否、人流史及次數(shù)、初次手術(shù)的單雙側(cè)、包塊大小、合并腺肌病與否的OR值均＞1，且上述因素的回歸系數(shù)β＞0(正相關(guān))，其中既往人流史、痛經(jīng)史、包塊大小的OR＞3；發(fā)病年齡、合并腺肌病的OR＞1.5。術(shù)后有妊娠史、術(shù)后輔助用藥、手術(shù)途徑為腹腔鏡的OR＜1，且回歸系數(shù)B＜0(負相關(guān))。 結(jié)論：1、卵巢子宮內(nèi)膜異位癥復發(fā)的獨立因素有首次發(fā)病年齡、痛經(jīng)與否、人流史及次數(shù)、術(shù)后用藥與否、初次手術(shù)時單雙側(cè)、手術(shù)途徑、術(shù)后妊娠與否、包塊大小、合并腺肌病與否。 2、首次發(fā)病年齡、痛經(jīng)與否、人流史及次數(shù)、初次手術(shù)的單雙側(cè)、包塊大小、合并腺肌與否這6個因素可能是卵巢子宮內(nèi)膜異位癥復發(fā)的危險因素。其中既往有人流史、合并痛經(jīng)、初次手術(shù)時的包塊大有可能為強危險因素;首次發(fā)病年齡、合并腺肌病可能是中等危險因素; 3、術(shù)后有妊娠史、術(shù)后輔助用藥、手術(shù)途徑為腹腔鏡可能是卵巢子宮內(nèi)膜異位癥術(shù)后復發(fā)的保護因素。 4、對于生育期的女性復發(fā)率高，手術(shù)途徑選取腹腔鏡可能降低復發(fā)率，術(shù)后應指導患者規(guī)范的用藥或術(shù)后妊娠，必要時輔以助孕技術(shù)。
[Abstract]:Objective : The incidence of endometriosis ( OM ) in ovarian endometriosis has been significantly increased in recent years . The common symptoms are dysmenorrhea , sexual intercourse and infertility . Clinical treatment is aimed at reducing the focus , reducing symptoms and promoting fertility .

Methods : From December 2010 to December 2012 in the Second Hospital of Jilin University from December 2010 to December 2012 , 377 patients with conservative operation of OM were selected , and the cases with recurrence were taken as observation group , and the cases with no recurrence were taken as control group , and the correlation factors were found according to the comparison of recurrence rate and regression coefficient .

Results : 1 . After operation , the recurrence rate was 13.73 % ( 49 / 357 ) .

The recurrence rate of the group was 13.74 % ( 29 / 211 ) . The recurrence rate of non - pregnant group was 13.74 % ( 29 / 211 ) . The recurrence rate of the two groups was 13.74 % ( 29 / 211 ) .

3 . The results of single - factor logistic regression analysis were as follows : first onset age , dysmenorrhea , history of abortion , number of times of abortion , postoperative medication or not . The wald values of single and bilateral , surgical approaches , post - operative pregnancy , the size of the pack , and the absence of combined adenomyopathy were 6.49 , 4.866 , 19.258 , 7.488 , 5.883 , 8.439 , 11.462 , 6.865 , 7.997 ( P < 0.05 ) .

4 . Multiple Logistic Regression Analysis Results : The OR value of first onset age , dysmenorrhea , flow history and number of times , single and double sides of primary surgery , size of bag , OR of combined adenomyopathy > 1 , and regression coefficient 尾 > 0 ( positive correlation ) of the above factors , including previous history of human history , history of dysmenorrhea , OR > 3 of packet size ;
OR > 1.5 . There was a history of pregnancy and auxiliary medication after operation . The operative route was OR < 1 , and the regression coefficient was B < 0 ( negative correlation ) .

Conclusion : 1 . The independent factors of recurrence of endometriosis include first onset age , dysmenorrhea , history of abortion , number of times of abortion , postoperative medication , single and double side , surgical approach , postoperative pregnancy or not , size of the block , and the presence or absence of combined adenopathy .

2 . The six factors such as age , dysmenorrhea , history and frequency of abortion , single and double sides of primary surgery , size of pack and whether combined adenoids may be a risk factor for the recurrence of endometriosis .

3 . There is a history of pregnancy and auxiliary medication after operation , which may be a protective factor for the recurrence of endometriosis after operation .

4 . For the high recurrence rate of female in the growing period , it is possible to reduce the recurrence rate by selecting the laparoscopic approach for the surgical approach , which should guide the medication or post - operative pregnancy of the patient ' s standard , and assisted with the technique of contraception if necessary .

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R711.71

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