【摘要】：目的:子宮內(nèi)膜異位癥手術(shù)聯(lián)合藥物治療方案多存在爭(zhēng)議,影響術(shù)后復(fù)發(fā)因素也存在很大爭(zhēng)議,本研究通過(guò)術(shù)后疼痛緩解、妊娠、復(fù)發(fā)情況分析腹腔鏡保守手術(shù)聯(lián)合Gn RHa(Gonadotropin-releasing hormone agonists,促性腺激素釋放激素激動(dòng)劑)不同治療方法的療效;研究子宮內(nèi)膜異位囊腫腹腔鏡保守手術(shù)后影響復(fù)發(fā)的相關(guān)因素。方法:收集2012年7月-2014年7月就診北京婦產(chǎn)醫(yī)院行腹腔鏡保守手術(shù),術(shù)中根據(jù)美國(guó)生育協(xié)會(huì)修正(r-AFS)的標(biāo)準(zhǔn)分期均為III期及以上,并經(jīng)病理證實(shí)為子宮內(nèi)膜異位癥的育齡期女性360例。隨訪時(shí)間為術(shù)后2-3年,共收集隨訪病例317例,失訪43例,失訪率11.94%。收錄臨床基本資料及術(shù)后妊娠情況進(jìn)行一般資料分析;根據(jù)術(shù)前術(shù)后是否聯(lián)合使用Gn RHa以及使用時(shí)間分組,通過(guò)術(shù)后疼痛緩解情況、復(fù)發(fā)率、妊娠率方面分析不同治療方法的療效;將術(shù)后復(fù)發(fā)與未復(fù)發(fā)患者的基本資料進(jìn)行統(tǒng)計(jì)分析,研究子宮內(nèi)膜異位囊腫患者手術(shù)后復(fù)發(fā)的相關(guān)因素。結(jié)果:302例患者術(shù)前血CA125值的P25 18.35 U/ml,P75 52.5U/ml。術(shù)前無(wú)癥狀、疼痛、不孕患者的囊腫位置分布差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。單純手術(shù)組、術(shù)后注射Gn RHa1-3針組、術(shù)后注射Gn RHa4-6針組在術(shù)后2-3年疼痛緩解情況、術(shù)后2-3年累計(jì)復(fù)發(fā)率、自然妊娠率方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。單純手術(shù)組、術(shù)前使用Gn RHa組、術(shù)后使用Gn RHa組、術(shù)前術(shù)后均使用Gn RHa組、術(shù)后放置左炔諾孕酮宮內(nèi)緩釋系統(tǒng)(LNG-IUS)組在術(shù)后2-3年疼痛緩解情況、術(shù)后2-3年累計(jì)復(fù)發(fā)率、自然妊娠率方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。將可能影響子宮內(nèi)膜異位囊腫術(shù)后復(fù)發(fā)的相關(guān)因素進(jìn)行l(wèi)ogistic回歸分析,術(shù)前CA125指標(biāo)(P0.05,OR值1,回歸系數(shù)0)可能為復(fù)發(fā)的危險(xiǎn)性因素;初潮年齡推遲(P0.05,OR值1,回歸系數(shù)0)可能為復(fù)發(fā)的保護(hù)性因素。術(shù)后自然受孕人群平均年齡29.32±3.75歲,術(shù)后不孕人群平均年齡31.86±4.40歲,二者具有統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后11名(3.47%)患者絕經(jīng),絕經(jīng)平均年齡48.18歲。術(shù)后27人(8.52%)月經(jīng)無(wú)規(guī)律,38人(11.99%)經(jīng)量減少,18人經(jīng)期縮短(5.68%),3人經(jīng)期延長(zhǎng)(0.95%)。結(jié)論:手術(shù)可能造成卵巢功能損傷,出現(xiàn)月經(jīng)不規(guī)律的情況;術(shù)后聯(lián)合使用Gn RHa對(duì)于術(shù)后2-3年疼痛的緩解、降低復(fù)發(fā)、提高妊娠率相比單純手術(shù)組無(wú)明顯優(yōu)勢(shì);同樣手術(shù)聯(lián)合Gn RHa、LNG-IUS治療相比單純手術(shù)組于術(shù)后2-3年療效也不理想;隨訪患者術(shù)后2-3年的復(fù)發(fā)率,發(fā)現(xiàn)術(shù)前CA125指標(biāo)可能為卵巢型子宮內(nèi)膜異位癥復(fù)發(fā)的危險(xiǎn)性因素、初潮年齡推遲可能為復(fù)發(fā)的保護(hù)性因素;術(shù)后自然妊娠率69.86%,術(shù)后自然受孕人群平均年齡與術(shù)后不孕人群平均年齡具有統(tǒng)計(jì)學(xué)差異,因此建議有生育要求的子宮內(nèi)膜異位癥患者術(shù)后盡早妊娠。
[Abstract]:Objective: there are many controversies in the combination of surgery and drug therapy for endometriosis, and the factors affecting the recurrence of endometriosis are also controversial. In this study, postoperative pain relief, pregnancy, To analyze the curative effect of laparoscopic conservative surgery combined with Gn RHa (Gonadotropin-releasing hormone agonists, gonadotropin releasing hormone agonist. To study the factors related to recurrence of endometrial cysts after laparoscopic conservative surgery. Methods: conservative laparoscopic surgery was performed at Beijing Obstetral Gynecology Hospital from July 2012 to July 2014. According to the standard staging of the American Fertility Association (r-AFS), stage III and above were all performed during the operation. And 360 women with endometriosis were confirmed by pathology. The follow-up period was 2-3 years. 317 cases were followed up and 43 cases were lost. The rate of missing visit was 11.94%. The basic clinical data and pregnancy after operation were collected and analyzed. According to whether combined use of Gn RHa before and after operation and time group, the curative effect of different treatment methods was analyzed through postoperative pain relief, recurrence rate and pregnancy rate. The basic data of postoperative recurrence and non-recurrence were statistically analyzed to study the related factors of postoperative recurrence of endometriosis cysts. Results: the preoperative CA125 of 302 patients was P 25 18.35 U / ml P 75 52.5 U / ml 路ml. There was no significant difference in the location of cysts in asymptomatic, pain and infertility patients before operation (P0.05). There was no significant difference in pain relief in postoperative 2-3 years, cumulative recurrence rate and natural pregnancy rate in postoperative 2-3 years in simple operation group, postoperative injection Gn RHa1-3 needle group and postoperative Gn RHa4-6 needle group (P0.05). In the simple operation group, Gn RHa group was used before operation, Gn RHa group was used after operation, Gn RHa group was used before and after operation, and the pain relief was observed in the group of intrauterine sustained release of levonorgestrel (LNG-IUS) for 2-3 years after operation. There was no significant difference in cumulative recurrence rate and natural pregnancy rate between 2-3 years after operation (P0.05). Logistic regression analysis showed that preoperative CA125 index (P0.05OR value 1, regression coefficient 0) might be the risk factor of recurrence. The delayed age of menarche (P 0.05 OR 1, regression coefficient 0) may be the protective factor of recurrence. The average age of spontaneous pregnancy group was 29.32 鹵3.75 years old, and that of infertile group was 31.86 鹵4.40 years old. There was statistical difference between the two groups (P0.05). There were 11 postmenopausal patients (3.47%) with an average age of 48.18 years. 27 cases (8.52%) had irregular menstruation, 38 cases (11.99%) decreased menstrual volume, 18 cases shortened menstrual period (5.68%), 3 cases prolonged menstrual period (0.95%). Conclusion: operation may result in ovarian function injury and irregular menstruation, postoperative combined use of Gn RHa can relieve pain, reduce recurrence and increase pregnancy rate in 2-3 years after operation. The effect of the same operation combined with Gn RHa,LNG-IUS was not satisfactory compared with that of the simple operation group in 2-3 years after operation. The recurrence rate of 2 to 3 years after follow-up showed that preoperative CA125 might be a risk factor for recurrence of ovarian endometriosis and delayed menarche might be a protective factor for recurrence. The natural pregnancy rate was 69.86, and the average age of the natural pregnant group was significantly different from that of the infertile group. Therefore, it was suggested that the endometriosis patients with fertility requirement should get pregnant as soon as possible after operation.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R711.71

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