本文選題：腹腔鏡 + 子宮腺肌病��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:子宮腺肌病(簡(jiǎn)稱(chēng)腺肌癥)(adenomyosis,AM)是指異位內(nèi)膜浸潤(rùn)正常的子宮肌層,周?chē)交〖?xì)胞增生包裹異位的內(nèi)膜上皮和基質(zhì)而形成病灶。腺肌病的漸進(jìn)性痛經(jīng)及不孕癥狀給患者帶來(lái)很大生活壓力及身心痛苦。臨床中常把子宮腺肌病患者歸為兩類(lèi):有生育要求和無(wú)生育要求。面對(duì)無(wú)生育要求的子宮腺肌病患者,臨床最常采用的手術(shù)方法是全子宮切除術(shù),但是這種術(shù)式常出現(xiàn)卵巢功能下降,殘留卵巢綜合癥,性功能下降等并發(fā)癥。本課題通過(guò)三種不同的術(shù)式治療子宮腺肌病,探尋一種療效顯著且能保護(hù)女性患者卵巢功能的手術(shù)方法。方法:2014年1月至2016年1月入院因子宮腺肌病行手術(shù)治療的患者病歷,按照納入及排出標(biāo)準(zhǔn),最終選擇91例進(jìn)行回顧性分析。該91例包括3組:觀察組為腹腔鏡下三角形子宮切除術(shù)(laparoscopic deltoid hysterectomy,LDH)組(30例),對(duì)照組分別為腹腔鏡下全子宮切除術(shù)(laparoscopic total hysterectomy,LTH)組(32例)、腹腔鏡下次全子宮切除術(shù)(laparoscopic subtotal hysterectomy,LSH)組(29例)。觀察手術(shù)時(shí)間、術(shù)中出血量、術(shù)后3個(gè)月、術(shù)后半年及1年的卵巢功能改變、術(shù)后1年的腹痛程度改變、B超改變及并發(fā)癥等指標(biāo)。結(jié)果:LDH組的手術(shù)時(shí)間與LTH、LSH組無(wú)差異(p0.05);LDH組的出血量與LTH、LSH組無(wú)差異(p0.05);LDH組術(shù)前與術(shù)后3個(gè)月、術(shù)后半年、術(shù)后1年的黃體生成素(luteinizing hormone,LH)、卵泡刺激素(follicle-stimulating hormone,FSH)、抗苗勒氏管激素(anti-mullerian hormone,AMH)值得比較均無(wú)顯著變化(p0.05);LTH組術(shù)前與術(shù)后3個(gè)月LH、FSH、AMH值得比較均無(wú)顯著變化(p0.05),但術(shù)后半年、術(shù)后1年的LH、FSH值顯著性升高(p0.05),AMH值均顯著降低(p0.05);LSH組術(shù)前與術(shù)后3個(gè)月、術(shù)后半年LH、FSH、AMH值的比較均無(wú)顯著變化(p0.05),但術(shù)后1年的LH、FSH值均顯著性升高(p0.05),AMH值顯著性降低(p0.05)。LDH、LTH、LSH三組在治療子宮腺肌病患者腹痛療效方面,差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);而三組手術(shù)在腹痛程度改變方面各自的術(shù)前與術(shù)后1年比較,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:1、腹腔鏡下三角形子宮切除術(shù)治療子宮腺肌病療效顯著,術(shù)后并發(fā)癥少,且能保護(hù)卵巢功能,符合無(wú)生育要求子宮腺肌病患者的生理及心理需求,值得臨床推廣。2、腹腔鏡下三角形子宮切除術(shù)不增加手術(shù)時(shí)間與出血量,與腹腔鏡下全子宮切除術(shù)、腹腔鏡下次全子宮切除術(shù)相似。
[Abstract]:Objective: adenomyosis (AM) refers to the ectopic endometrium infiltrating the normal myometrium and the peripheral smooth muscle cells proliferating around the ectopic endometrial epithelium and matrix. Progressive dysmenorrhea and infertility of adenomyosis bring great life pressure and physical and mental pain. Clinical adenomyosis is often classified into two categories: fertility requirements and fertility requirements. Total hysterectomy is the most common surgical method in patients with adenomyosis without fertility requirements. However, the complications such as ovarian dysfunction, residual ovarian syndrome and sexual dysfunction are often found in this procedure. In this study, three different surgical methods were used to treat adenomyosis and to find a method that can protect the ovarian function of female patients. Methods: from January 2014 to January 2016, 91 patients with adenomyosis who were admitted to hospital for surgical treatment were retrospectively analyzed according to the criteria of inclusion and exclusion. The 91 cases were divided into three groups: the observation group (30 cases), the control group (32 cases) and the next laparoscopic hysterectomy group (laparoscopic subtotal hysterectomytomy LSH) group (29 cases), the observation group (30 cases), the control group (32 cases), the next laparoscopic hysterectomy group (laparoscopic subtotal hysterectomyl LSH) group (30 cases), the control group (32 cases), the next laparoscopic hysterectomy group (laparoscopic subtotal hysterectomytomy LSH) group (29 cases). The time of operation, the amount of intraoperative bleeding, the changes of ovarian function in 3 months, 6 months and 1 year after operation, the degree of abdominal pain in 1 year after operation, the changes of B-ultrasound and complications were observed. Results there was no significant difference in the operative time between the two groups (p0.05). There was no difference in the amount of blood loss between the LDH group and the LTHH LSH group (p0.05). There was no difference between the two groups before and after operation (p0.05), and there was no difference between the two groups before and after operation (p0.05). There were no significant changes in luteinizing hormone LH, follicle-stimulating moneystimulating hormone, anti-mullerian moneymotropin (p0.05) before and 3 months after operation in LTH group (p0.05), but no significant changes were found in half a year after operation (p0.05), but there was no significant difference between the two groups (p0.05), but there was no significant difference between them before and after operation (p0.05), but half a year after operation, there was no significant difference between the two groups (p0.05), but half a year after operation, there was no significant difference between the two groups (p0.05). One year after operation, the FSH value of LHG increased significantly (p0.05) and AMH decreased significantly (p0.05) in LSH group before operation and 3 months after operation. There was no significant change in AMH value in half a year after operation (p0.05), but the value of FSH increased significantly (p0.05) and AMH significantly decreased (p0.05). LDH LTHH LSH in the three groups in the treatment of abdominal pain in patients with adenomyosis was significantly higher (p0.05), and the value of AMH was significantly decreased (p0.05) in the treatment of abdominal pain in patients with adenomyosis. There was no significant difference in the degree of abdominal pain between the three groups (p0.05), and there was a significant difference in the degree of abdominal pain between the three groups before operation and one year after operation (p0.05). ConclusionLaparoscopic triangular hysterectomy is effective in the treatment of adenomyosis with fewer complications, and can protect ovarian function and meet the physiological and psychological needs of patients with adenomyosis without fertility. It is worth popularizing. 2. Laparoscopic triangular hysterectomy does not increase the operative time and blood loss. It is similar to total hysterectomy under laparoscope and the next total hysterectomy under laparoscope.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R713.4

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