保守性手术后子宫内膜异位症的临床分析
Clinical analyses of endometriosis after conservative surgery.
作者信息
Ke Xiaoping, Qian Haihong, Kang Le, Wang Jin, Xie Yan, Cheng Zhongping
机构信息
Department of Obstetrics and Gynecology, Yangpu District Central Hospital Shanghai 200090, China.
出版信息
Int J Clin Exp Med. 2015 Nov 15;8(11):21703-6. eCollection 2015.
OBJECTIVE
To assess the remission rate and outcome of pregnancy of patients who had moderate and severe ovarian endometriosis after conservative surgery. We also wished to analyze the associated factors of recurrence.
METHODS
Weconducted retrospective analyses of 199 cases with stage II-IV ovarian endometriosis who had preserved fertility under laparoscopic surgical treatment. Postoperatively, the 199 patients were divided into three groups: 43 cases underwent surgical treatment alone (group A); 47 were given a gonadotropin-releasing hormone agonist (GnRH-α) (group B), and 109 were given mifepristone (group C). Ten cases in group A were infertile, 26 cases in group B, and 38 cases in group C. All patients were followed up for 3 years. This study was approved by the Ethics Committee of Yangpu District Central Hospital.
RESULTS
In groups A, B and C, the remission rate was 58.13%, 70.21% and 60.55% and the difference not significant (P=0.384); Recurrence rates were 27.90%, 12.76% and 24.77%, and the difference between them significant (P<0.05). The recurrence rate in group B was the lowest. The natural pregnancy rate after surgery in the three study groups (untreated, GnRH-α and mifepristone) was 30%, 34.61% and 28.94% but this difference was not significant.
CONCLUSION
Surgery can improve the symptom remission rate and fertility of patients. Postoperative drug therapy does not improve the chance of pregnancy.
目的
评估中重度卵巢子宫内膜异位症患者保守性手术后的缓解率及妊娠结局。我们还希望分析复发的相关因素。
方法
对199例接受腹腔镜手术治疗且保留生育功能的II-IV期卵巢子宫内膜异位症患者进行回顾性分析。术后，199例患者分为三组：43例仅接受手术治疗（A组）；47例给予促性腺激素释放激素激动剂（GnRH-α）（B组），109例给予米非司酮（C组）。A组10例不孕，B组26例，C组38例。所有患者随访3年。本研究经杨浦区中心医院伦理委员会批准。
结果
A、B、C三组的缓解率分别为58.13%、70.21%和60.55%，差异无统计学意义（P=0.384）；复发率分别为27.90%、12.76%和24.77%，差异有统计学意义（P<0.05）。B组复发率最低。三个研究组（未治疗、GnRH-α和米非司酮）术后自然妊娠率分别为30%、34.61%和28.94%，但差异无统计学意义。
结论
手术可提高患者症状缓解率和生育能力。术后药物治疗不能提高妊娠几率。
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