Vercellini Paolo, Aimi Giorgio, Busacca Mauro, Apolone Giovanni, Uglietti Anna, Crosignani Pier Giorgio
Reproductive Surgery Unit, First Department of Obstetrics and Gynecology, University of Milan, Milan, Italy.
Fertil Steril. 2003 Aug;80(2):310-9. doi: 10.1016/s0015-0282(03)00613-7.
To evaluate the efficacy of laparoscopic resection of the uterosacral ligaments in women with endometriosis and predominantly midline dysmenorrhea.
Randomized controlled trial.
Two academic departments. One hundred eighty patients undergoing operative laparoscopy as first-line therapy for stage I to IV symptomatic endometriosis.
INTERVENTION(S): Operative laparoscopy including uterosacral ligament resection or conservative surgery alone.
MAIN OUTCOME MEASURE(S): Proportion of women with recurrence of moderate or severe dysmenorrhea 1 year after surgery.
RESULT(S): No complications occurred. Among the patients who were evaluable 1 year after operative laparoscopy, 23 of 78 (29%) women who had uterosacral ligament resection and 21 of 78 (27%) women who had conservative surgery only reported recurrent dysmenorrhea. The corresponding numbers of patients at 3 years were 21 of 59 (36%) women and 18 of 57 (32%) women, respectively. Time to recurrence was similar in the two groups. Pain was substantially reduced, and patients in both groups experienced similar and significant improvements in health-related quality of life, psychiatric profile, and sexual satisfaction. Overall, 68 of 90 (75%) patients in the uterosacral ligament resection group and 67 of 90 (74%) patients in the conservative surgery group were satisfied at 1 year.
CONCLUSION(S): Addition of uterosacral ligament resection to conservative laparoscopic surgery for endometriosis did not reduce the medium- or long-term frequency and severity of recurrence of dysmenorrhea.
评估腹腔镜子宫骶韧带切除术对患有子宫内膜异位症且以中线痛经为主的女性的疗效。
随机对照试验。
两个学术科室。180例接受手术腹腔镜检查作为I至IV期有症状子宫内膜异位症一线治疗的患者。
手术腹腔镜检查，包括子宫骶韧带切除术或单纯保守手术。
术后1年中度或重度痛经复发的女性比例。
未发生并发症。在手术腹腔镜检查后1年可评估的患者中，78例接受子宫骶韧带切除术的女性中有23例（29%），78例仅接受保守手术的女性中有21例（27%）报告痛经复发。3年时相应的患者人数分别为59例女性中的21例（36%）和57例女性中的18例（32%）。两组的复发时间相似。疼痛明显减轻，两组患者在健康相关生活质量、精神状况和性满意度方面都有相似且显著的改善。总体而言，子宫骶韧带切除术组90例患者中有68例（75%），保守手术组90例患者中有67例（74%）在1年时表示满意。
在子宫内膜异位症的保守性腹腔镜手术中增加子宫骶韧带切除术并没有降低痛经复发的中长期频率和严重程度。
