【摘要】：目的:本研究的目的是確定卵巢型子宮內(nèi)膜異位癥保守性手術(shù)治療后疾病復(fù)發(fā)的相關(guān)因素。方法:選取2010年1月至2014年6月于河北醫(yī)科大學(xué)第四醫(yī)院因卵巢型子宮內(nèi)膜異位癥行保守性手術(shù)治療的患者560例,隨訪時間至少2年,對完成隨訪的患者進(jìn)行回顧性分析研究。復(fù)發(fā)的診斷標(biāo)準(zhǔn)為術(shù)后2年內(nèi)經(jīng)陰道超聲檢查發(fā)現(xiàn)典型的卵巢子宮內(nèi)膜異位囊腫影像,且超聲提示囊腫直徑2cm。觀察并評價發(fā)病年齡、不孕、術(shù)前孕次、術(shù)前產(chǎn)次、既往宮腔操作史、剖宮產(chǎn)史、既往內(nèi)異癥治療史、術(shù)前血清CA125水平、疼痛、后穹隆觸痛結(jié)節(jié)、合并子宮肌瘤、合并子宮腺肌病、合并深部浸潤型子宮內(nèi)膜異位癥(DIE)、手術(shù)方式、術(shù)中美國生殖醫(yī)學(xué)協(xié)會修訂的內(nèi)異癥分期標(biāo)準(zhǔn)(ASRM)分期、多發(fā)囊腫、最大囊腫直徑、內(nèi)異癥病變側(cè)別、術(shù)后促性腺激素釋放激素激動劑(Gn RH-a)類藥物治療、術(shù)后Gn RH-a類藥物治療療程(≤3次/3次)及術(shù)后妊娠21項變量對術(shù)后復(fù)發(fā)的影響。行l(wèi)ogistic回歸分析篩查疾病復(fù)發(fā)的相關(guān)因素。結(jié)果:1 560例患者中完成隨訪患者528例,隨訪率94.29%;其中有102例患者病變復(fù)發(fā),復(fù)發(fā)率19.32%。2單變量分析顯示,復(fù)發(fā)相關(guān)危險因素包括既往內(nèi)異癥治療史(P0.0001)、疼痛(P=0.035)、后穹隆觸痛結(jié)節(jié)(P=0.003)、手術(shù)方式(P=0.014)、最大囊腫直徑(P0.0001)及雙側(cè)病變(P=0.031);保護因素包括術(shù)后使用Gn RH-a類藥物治療(P=0.005)及術(shù)后妊娠(P0.0001)。3多變量logistic回歸分析發(fā)現(xiàn),術(shù)后復(fù)發(fā)的獨立危險因素包括既往內(nèi)異癥治療史[OR=4.148,95%CI=1.939-8.870,P0.0001]、后穹隆觸痛結(jié)節(jié)[OR=3.332,95%CI=1.442-7.702,P=0.005]、最大囊腫直徑[OR=2.332,95%CI=1.443-3.769,P=0.001]及雙側(cè)病變[OR=1.780,95%CI=1.092-2.901,P=0.021];術(shù)后復(fù)發(fā)的獨立保護因素包括術(shù)后使用Gn RH-a類藥物治療[OR=0.562,95%CI=0.351-0.900,P=0.016]及術(shù)后妊娠[OR=0.180,95%CI=0.089-0.361,P0.0001]。結(jié)論:1卵巢型子宮內(nèi)膜異位癥保守性手術(shù)治療后復(fù)發(fā)與患者的臨床特征密切相關(guān)。2既往有內(nèi)異癥治療史、后穹隆有觸痛結(jié)節(jié)、最大囊腫直徑大及雙側(cè)病變是卵巢型子宮內(nèi)膜異位癥保守性手術(shù)治療后復(fù)發(fā)的獨立危險因素。3術(shù)后使用Gn RH-a類藥物治療及術(shù)后妊娠是卵巢型子宮內(nèi)膜異位癥保守性手術(shù)治療后復(fù)發(fā)的獨立保護因素。4臨床中在治療卵巢型子宮內(nèi)膜異位癥的患者時,應(yīng)充分結(jié)合上述與復(fù)發(fā)相關(guān)的獨立影響因素綜合考慮,選擇合適的手術(shù)時機。對有復(fù)發(fā)危險因素的患者術(shù)后應(yīng)積極使用Gn RH-a類藥物治療并密切隨訪,警惕疾病復(fù)發(fā)的可能性。有生育要求的患者,應(yīng)鼓勵其術(shù)后盡快妊娠。
[Abstract]:Objective: to determine the risk factors for recurrence of ovarian endometriosis after conservative surgery. Methods: from January 2010 to June 2014, 560 patients with ovarian endometriosis were treated by conservative operation in the fourth Hospital of Hebei Medical University. The follow-up time was at least 2 years. The diagnostic criterion of recurrence was to find typical ovarian endometriosis cysts by transvaginal ultrasound within 2 years after operation, and the diameter of the cysts was 2 cm by ultrasonography. To observe and evaluate the age of onset, infertility, preoperative pregnancy, preoperative delivery, previous history of intrauterine operation, history of cesarean section, history of treatment of endometriosis, preoperative serum CA125 level, pain, posterior fornix tenderness nodule, hysteromyoma. Adenomyosis complicated with deep invasive endometriosis, (DIE), operation, (ASRM) staging revised by American Association of Reproductive Medicine, multiple cysts, maximum cyst diameter, pathological side of endometriosis. Postoperative effects of gonadotropin releasing hormone agonist (Gn RH-a) drug therapy, postoperative Gn RH-a treatment course (鈮，

本文編號：2276412