摘要： 目的 探讨采用保守性手术治疗卵巢型子宫内膜异位症患者的临床疗效。方法 回顾性分析195例采用保守性手术治疗的卵巢型子宫内膜异位症患者的临床资料，收集并记录一般临床资料、术后复发情况和药物治疗不良反应情况。结果 195例患者中25例复发，复发率12.82%。复发组与未复发组比较，年龄（t=1.245，P=0.215）、卵巢肿瘤直径（t=1.266，P=0.207）、术前CA125水平（Z=-0.129，P=0.897）、r-ASRM评分（t=1.087，P=0.278）、存在双侧卵巢病灶（χ²=1.277，P=0.258）、术前妊娠（χ²=1.435，P=0.231）、术前合并痛经（χ²=0.003，P=0.955）、术前合并慢性盆腔痛（χ²=0.131，P=0.717）、合并子宫肌瘤（χ²=1.103，P=0.294）、合并子宫腺肌症（χ²=0.001，P=0.973）、合并深部浸润型子宫内膜异位症（χ²=1.439，P=0.230）、二次手术（χ²=0.936，P=0.333）、术后未用药（χ²=0.190，P=0.663）以及分期Ⅲ~Ⅳ期（χ²=1.181，P=0.277）这14个复发因素均无统计学差异。195例患者中术后药物治疗133例，占68.21%，术后妊娠率20.00%，术后缓解率94.36%。结论 卵巢型子宫内膜异位症保守性手术治疗能够有效缓解育龄期患者的临床症状，术后辅助药物治疗能降低疾病复发率，但术后长期使用促性腺激素释放激素激动剂类药物不良反应发生率较高，需尽早进行反向添加治疗。

卵巢型子宫内膜异位症患者保守性手术治疗效果

吕艳红¹, 吴涵², 贺媛媛¹, 李玲霞¹, 刘淑娟¹

1. 空军军医大学第一附属医院妇产科, 西安 710032;
2. 周至县人民医院妇产科, 西安 710400

收稿日期:2020-03-16出版日期:2021-01-30发布日期:2021-01-06
通讯作者:刘淑娟E-mail:hanliu@fmmu.edu.cn
作者简介:吕艳红(1989-),女,主治医师,硕士.
基金资助:国家自然科学基金（81972427）；空军军医大学第一附属医院临床助推计划（XJZT18ML45）


关键词: 卵巢型子宫内膜异位症, 保守性手术, 复发, 术后药物治疗
Abstract: Objective To explore the clinical efficacy of conservative surgery in the treatment of ovarian endometriosis. Methods The clinical data of 195 patients with ovarian endometriosis treated by conservative surgery were retrospectively analyzed. The general clinical data,postoperative recurrence,and adverse drug reactions were recorded. Results Of the 195 patients,relapse was reported in 25,with a recurrence rate of 12.82%. No significant difference was found in the 14 recurrence-related factors,namely,age (t=1.245,P=0.215),ovarian tumor diameter (t=1.266,P=0.207),preoperative CA125 value (Z=-0.129,P=0.897),r-ASRM score (t=1.087,P=0.278),presence of bilateral ovarian lesions (χ²=1.277,P=0.258),preoperative pregnancy (χ²=1.435,P=0.231),preoperative dysmenorrhea (χ²=0.003,P=0.955),preoperative chronic pelvic pain (χ²=0.131,P=0.717),presence of hysteromyoma (χ²=1.103,P=0.294),presence of adenomyosis (χ²=0.001,P=0.973),complication with deep invasive endometriosis (χ²=1.439,P=0.230),secondary operation (χ²=0.936,P=0.333),no medication after operation (χ²=0.190,P=0.663),and stage Ⅲ and Ⅳ (χ²=1.181,P=0.277),between the recurrence and non-recurrence groups (all P > 0.05). Among the 195 patients,133 (68.21%) were treated with postoperative drugs,and the postoperative pregnancy rate was 20.00%. The postoperative remission rate was 94.36%. Conclusion Conservative surgical treatment of ovarian endometriosis can effectively alleviate the clinical symptoms of patients of childbearing age,and postoperative adjuvant drug treatment can reduce the recurrence rate of the disease. The incidence of adverse reactions caused by long-term use of gonadotropin-releasing hormone agonist after surgery is high,requiring reverse addition treatment as soon as possible.
Key words: ovarian endometriosis, conservative surgery, recurrence, postoperative drug treatment
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