本文選題：卵巢子宮內(nèi)膜異位癥 + 腹腔鏡　； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的：通過對(duì)腹腔鏡和開腹手術(shù)兩種方法治療卵巢子宮內(nèi)膜異位癥的療效觀察，綜合各項(xiàng)指標(biāo)分析腹腔鏡手術(shù)和開腹手術(shù)的臨床意義，以期達(dá)到對(duì)其手術(shù)治療方法更全面的認(rèn)識(shí)，為其治療提供一定的理論基礎(chǔ)。 方法：收集吉林大學(xué)白求恩第一醫(yī)院婦產(chǎn)科2011年1月至2013年1月期間收治的208例卵巢子宮內(nèi)膜異位癥患者，，根據(jù)患者自愿選擇手術(shù)方式的原則分為腹腔鏡和開腹2組。采用回顧性病例對(duì)照分析的方法對(duì)2組患者年齡、囊腫大小，內(nèi)異癥分期及CA125水平、手術(shù)方式、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后排氣時(shí)間、住院時(shí)間、癥狀緩解預(yù)后恢復(fù)等幾個(gè)方面進(jìn)行分析。 結(jié)果：1、兩組患者手術(shù)情況比較，腹腔鏡手術(shù)及傳統(tǒng)開腹手術(shù)均能順利完成，其中1例腹腔鏡手術(shù)中轉(zhuǎn)開腹。腹腔鏡組的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后排氣時(shí)間、住院時(shí)間、術(shù)后發(fā)熱時(shí)間明顯少于開腹組，兩組差異有統(tǒng)計(jì)學(xué)意義（P0.05）。2、2組術(shù)后并發(fā)癥比較，腹腔鏡組術(shù)后無并發(fā)癥發(fā)生。開腹手術(shù)組有1例出現(xiàn)切口脂肪液化，給予對(duì)癥處理后切口愈合良好，其余兩組切口均甲級(jí)愈合。3、2組術(shù)后復(fù)發(fā)情況比較，所有患者均從手術(shù)后1個(gè)月后開始定期進(jìn)行門診復(fù)查，隨訪6-24個(gè)月。其中術(shù)后復(fù)發(fā)5例，均為一側(cè)卵巢囊腫剝除術(shù)后患者，其中腹腔鏡組3例，開腹組2例。其中4例進(jìn)行保守治療，1例再次行腹腔鏡治療后治愈。兩組復(fù)發(fā)率比較差異不顯著無統(tǒng)計(jì)學(xué)意義。（P0.05）4、有生育要求的40例患者中，采取傳統(tǒng)開腹手術(shù)共計(jì)18例，術(shù)后隨訪有4例患者妊娠（22、22%），其中1年內(nèi)妊娠0人。采取腹腔鏡手術(shù)患者22例，5例妊娠（22、72%），其中1年內(nèi)妊娠2人。 結(jié)論： 1、腹腔鏡手術(shù)術(shù)中出血量、手術(shù)時(shí)間、術(shù)后排氣時(shí)間、住院時(shí)間、術(shù)后發(fā)熱時(shí)間等方面要明顯低于開腹手術(shù)。。 2、腹腔鏡手術(shù)住院時(shí)間短，術(shù)后疼痛輕，患者疤痕小，恢復(fù)快。如果術(shù)后復(fù)發(fā)，再次手術(shù)創(chuàng)傷小，切口愈合快。 3、接受開腹手術(shù)和腹腔鏡手術(shù)兩種術(shù)式的患者的復(fù)發(fā)率、妊娠率及術(shù)后臨床癥狀緩解率的改善情況相似。 4、手術(shù)治療是卵巢子宮內(nèi)膜異位癥的首選方法，主要為傳統(tǒng)的開腹手術(shù)和腹腔鏡手術(shù)，術(shù)式的選擇應(yīng)根據(jù)患者年齡、生育要求及臨床癥狀做到個(gè)體化。
[Abstract]:Objective: to observe the curative effect of laparoscopy and laparotomy in the treatment of ovarian endometriosis, and to analyze the clinical significance of laparoscopy and laparotomy. In order to achieve a more comprehensive understanding of its surgical treatment, to provide a certain theoretical basis for its treatment. Methods: 208 patients with ovarian endometriosis admitted from January 2011 to January 2013 in the first Hospital of Gynecology and Obstetrics of Jilin University were divided into two groups: laparoscopy and laparotomy according to the principle of voluntary choice of surgical methods. The age, size of cysts, staging of endometriosis and CA125 level, operation mode, operative time, intraoperative bleeding volume, postoperative exhaust time, hospital stay were analyzed by retrospective case-control analysis. Symptom relief, prognosis recovery and other aspects were analyzed. Results compared with the two groups, laparoscopic surgery and traditional open surgery were performed successfully, one of them was converted to open surgery. The operative time, intraoperative bleeding volume, postoperative exhaust time, hospitalization time and postoperative fever time in the laparoscopy group were significantly less than those in the open group. The difference between the two groups was statistically significant (P 0.05). There were no postoperative complications in the laparoscopy group. The incision fat liquefaction occurred in 1 case in the open operation group, and the incision healed well after the symptomatic treatment. The recurrence of the other two groups was compared after operation. All the patients began to carry out regular outpatient reexamination one month after the operation. Follow-up 6-24 months. Among them, 5 cases recurred after operation, all of them were treated with unilateral ovarian cyst excision, including laparoscopic group (3 cases) and open group (2 cases). Among them, 4 cases received conservative treatment and 1 case was cured by laparoscopy. There was no significant difference in the recurrence rate between the two groups. There was no significant difference between the two groups. Among the 40 patients with fertility requirement, 18 cases were treated with traditional open surgery. 4 cases were followed up after operation, among which 0 cases were pregnant within 1 year. 22 cases of laparoscopy were performed in 5 cases of pregnancy, among which 2 cases were pregnant within 1 year. Conclusion: 1.The amount of blood loss, operative time, postoperative exhaust time, hospitalization time and postoperative fever time in laparoscopic surgery were significantly lower than those in laparotomy. 2.Laparoscopic surgery has short hospitalization time, mild postoperative pain, small scar and quick recovery. If recurrence occurs again, the wound will be minimal and the incision will heal quickly. 3. The recurrence rate, pregnancy rate and relief rate of clinical symptoms of patients undergoing laparoscopy and open surgery were similar. 4, surgical treatment is the first choice of ovarian endometriosis, mainly for the traditional laparotomy and laparoscopic surgery, the choice of operation should be individualized according to the patient's age, fertility requirements and clinical symptoms.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R713.6

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