發(fā)布時(shí)間：2018-06-17 23:48

  本文選題：子宮內(nèi)膜異位癥 + 腹腔鏡手術(shù)��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的：分析子宮內(nèi)膜異位癥腹腔鏡保守性手術(shù)后聯(lián)合使用與不使用促性腺激素釋放激素激動(dòng)劑(gonadotropin-releasing-hormone agonist,GnRHa)的臨床療效及影響子宮內(nèi)膜異位癥術(shù)后復(fù)發(fā)的相關(guān)因素。 方法：收集2009年6月-2012年6月在山東大學(xué)齊魯醫(yī)院婦科行腹腔鏡保守性手術(shù)治療并經(jīng)術(shù)后病理證實(shí)為卵巢子宮內(nèi)膜異位囊腫同時(shí)伴或不伴有其他類型子宮內(nèi)膜異位癥的220例患者,隨訪截至到2014年6月,所有患者隨訪時(shí)間均滿2年,共完成隨訪180例,失訪率18.18%。所有患者均按照1985年美國(guó)生育協(xié)會(huì)r-AFS修正標(biāo)準(zhǔn)進(jìn)行分期,其中臨床分期為Ⅰ-Ⅱ期的患者共66例,Ⅲ-Ⅳ期患者共114例。按照術(shù)后是否使用GnRHa及使用周期的長(zhǎng)短分為單純手術(shù)組(90例),GnRHa3個(gè)月組(54例)以及GnRHa6個(gè)月組(36例),比較3組患者術(shù)后的疼痛癥狀緩解率及改善率、復(fù)發(fā)率以及不孕患者的妊娠率。同時(shí),將研究對(duì)象中術(shù)后復(fù)發(fā)與未復(fù)發(fā)患者的臨床資料進(jìn)行對(duì)比研究,分析影響子宮內(nèi)膜異位癥患者腹腔鏡保守性手術(shù)后復(fù)發(fā)的相關(guān)因素。 結(jié)果： ①單純手術(shù)組術(shù)前有疼痛癥狀者為66例,無(wú)疼痛癥狀者24例。GnRHa3月組術(shù)前有疼痛癥狀患者42例,無(wú)疼痛癥狀者12例。GnRHa6月組術(shù)前有疼痛癥狀者30例,無(wú)疼痛癥狀者6例。腹腔鏡保守性手術(shù)后,單純手術(shù)組的疼痛癥狀緩解率為38.9%,改善率為61.1%；GnRHa3月組緩解率為52.4%,改善率為47.6%：GnRHa6月組緩解率為73.3%,改善率為26.7%。GnRHa6月組的緩解率及改善率與單純手術(shù)組及GnRHa3月組相比,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)；GnRHa3個(gè)月組與單純手術(shù)相比較,改善率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),癥狀緩解率升高,但無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。 ②單純手術(shù)組術(shù)后復(fù)發(fā)者16例,總復(fù)發(fā)率為17.8%,術(shù)后第1年復(fù)發(fā)率為11.1%,術(shù)后第2年復(fù)發(fā)率為6.6%,復(fù)發(fā)時(shí)間平均為13.26±3.12月；GnRHa3月組術(shù)后復(fù)發(fā)者6例,總復(fù)發(fā)率為11.1%,術(shù)后第1年復(fù)發(fā)率為5.6%,術(shù)后2年復(fù)發(fā)率為5.6%,復(fù)發(fā)時(shí)間平均為14.74±2.39月；GnRHa6月組術(shù)后復(fù)發(fā)者2例,總復(fù)發(fā)率為5.6%,術(shù)后1年復(fù)發(fā)率為2.7%,術(shù)后第2年復(fù)發(fā)率為2.7%,復(fù)發(fā)時(shí)間平均為18.47±4.85月。GnRHa3月組與單純手術(shù)組的總復(fù)發(fā)率、術(shù)后第1、2年復(fù)發(fā)率及平均復(fù)發(fā)時(shí)間上比較均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；GnRHa6月組總復(fù)發(fā)率、術(shù)后第1、2年的復(fù)發(fā)率及平均復(fù)發(fā)時(shí)間與單純手術(shù)組及GnRHa3月組比較,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。 ③單純手術(shù)組不孕患者39例,術(shù)后妊娠者12例,總?cè)焉锫蕿?0.8%,術(shù)后第1年妊娠率為17.9%,術(shù)后第2年妊娠率為12.8%；GnRHa3月組不孕患者共33例,術(shù)后妊娠者10例,總?cè)焉锫蕿?0.3%,術(shù)后第1年妊娠率為12.1%,術(shù)后第2年妊娠率為18.2%；GnRHa6月組不孕患者共12例,術(shù)后妊娠者5例,總?cè)焉锫蕿?1.6%,術(shù)后第1年妊娠率為16.7%%,術(shù)后第2年妊娠率為25.0%；GnRHa6個(gè)月組、單純手術(shù)組及GnRHa3個(gè)月組三組兩兩比較,術(shù)后總?cè)焉锫省⑿g(shù)后第1年妊娠率,術(shù)后第2年妊娠率差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 ④180例研究對(duì)象發(fā)生術(shù)后復(fù)發(fā)者共24例,未復(fù)發(fā)者156例。通過(guò)對(duì)臨床資料的單因素分析發(fā)現(xiàn),復(fù)發(fā)者與未復(fù)發(fā)者相比較,在宮腔手術(shù)操作史、既往內(nèi)異癥手術(shù)史、囊腫側(cè)別(雙側(cè))、術(shù)后使用抗EMS藥物(GnRHa),術(shù)后妊娠方面比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。在年齡、初潮年齡、初次生育年齡、術(shù)前孕產(chǎn)次、術(shù)前使用抗內(nèi)異癥藥物、術(shù)前CA-125數(shù)值、病程、痛經(jīng)、r-AFS分期、內(nèi)異癥類型、囊腫直徑等方面比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。多因素logistic回歸分析發(fā)現(xiàn),宮腔手術(shù)操作史、內(nèi)異癥手術(shù)史、囊腫側(cè)別3個(gè)指標(biāo)均為內(nèi)異癥復(fù)發(fā)的危險(xiǎn)性因素,而術(shù)后使用抗Ems藥物(6個(gè)月GnRHa)及術(shù)后妊娠是內(nèi)異癥復(fù)發(fā)的保護(hù)性因素。 結(jié)論： 1.腹腔鏡保守性手術(shù)后聯(lián)合使用GnRHa6個(gè)月能有效改善子宮內(nèi)膜異位癥患者的臨床癥狀、預(yù)防術(shù)后復(fù)發(fā),延遲復(fù)發(fā)時(shí)間,但對(duì)于提高內(nèi)異癥不孕患者的術(shù)后妊娠率無(wú)明顯影響。 2.既往內(nèi)異癥手術(shù)史、既往宮腔操作手術(shù)史,病變側(cè)別(雙側(cè))是子宮內(nèi)膜異位癥患者術(shù)后復(fù)發(fā)的危險(xiǎn)性因素。臨床上對(duì)于有復(fù)發(fā)危險(xiǎn)因素的患者應(yīng)加強(qiáng)隨訪,并根據(jù)病人的具體情況制定個(gè)體化的治療方案。術(shù)后妊娠是內(nèi)異癥術(shù)后復(fù)發(fā)的保護(hù)性因素。對(duì)于有生育要求的患者,無(wú)論是否伴有不孕,均應(yīng)爭(zhēng)取在術(shù)后盡快妊娠,必要時(shí)可選擇輔助生殖技術(shù)助孕,增加妊娠幾率。
[Abstract]:Objective: to analyze the clinical efficacy of combined use and non use of gonadotropin releasing hormone agonist (gonadotropin-releasing-hormone agonist, GnRHa) after laparoscopic conservative surgery for endometriosis and the related factors affecting the recurrence of endometriosis after operation.
Methods: 220 cases of ovarian endometriosis cyst with or without other endometriosis were confirmed in the Department of gynaecology, Qilu Hospital, Shandong University, June 2009 -2012 June. All patients were followed up to June 2014. All patients were followed up for 2 years. All patients were followed up to the end of June 2014. All patients were followed up for a total of 2 years. All patients were followed up in 180 cases. All patients who had lost the rate of 18.18%. were staging according to the r-AFS revised standard of the American Fertility Association in 1985. There were 66 cases in stage I - II and 114 patients in stage III - IV. The patients were divided into simple operation group (90 cases), GnRHa3 month group (54 cases) and GnRHa6 according to whether the use of GnRHa and the length of the use period after operation. In the month group (36 cases), the rate of relieving and improving the symptoms of pain, the rate of improvement, the rate of recurrence and the rate of pregnancy in the 3 groups were compared, and the clinical data of the patients who had relapsed after the operation were compared and the related factors affecting the recurrence of the patients with endometriosis after laparoscopy were analyzed.
Result錛，

本文編號(hào)：2033008