【作者】 洪奇喜；

【导师】 郑志群；

【作者基本信息】 福建医科大学 ， 妇产科学， 2009， 硕士

【摘要】 研究目的搜集整理统计福建医科大学附属协和医院277例子宫内膜异位症患者的临床资料,对其术后复发相关因素及复发治疗进行分析。研究方法为病例分析研究。搜集、整理、随访2002年1月至2006年12月在福建医科大学附属协和医院妇产科住院的子宫内膜异位症患者的临床资料,将所得数据输入统计软件SPSS13.0进行统计分析。研究结果1. EM患者中保守性手术治疗112例,术后复发22例,复发率为19.6%,半根治性手术治疗73例,术后复发5例,复发率为6.8%,根治性手术治疗57例,术后复发0例,复发率为0%。2.对保守性手术组可能与复发有关的因素进行单因素和多因素统计学分析,经单变量分析,年龄、术后药物治疗、不孕、后穹隆触痛结节、术后孕次有统计学差异(P<0.05);多变量Logistic回归分析,相关因素为:年龄(OR 0.863,P<0.05),术后孕次(OR 0.115,P<0.05),术后药物治疗(OR 1.344,P<0.05),后穹隆触痛结节(OR 4.446,P<0.05)。3.保守性手术组Ⅲ-Ⅳ期患者血清CA125数值及阳性率均较Ⅰ-Ⅱ期患者高,两组相比均有统计学意义。4.对保守性手术术后复发的患者应用GnRHa治疗3个月后患者的盆腔症状明显缓解,复查B超异位囊肿缩小,血清CA125值下降,与治疗前相比有统计学意义。5.半根治性手术行全子宫切除术的复发率为6.3%,次全子宫切除术的复发率为8.0%,两者复发率无统计学差异(P>0.05)。6.根治性手术后未发现复发病例,有待进一步随访观察。结论通过统计学分析,发现EM保守性手术后复发的相关因素为:后穹隆触痛结节、术后孕次、术后药物治疗、年龄,提示后穹隆触痛结节、术后孕次、术后是否药物治疗、年龄是复发的关键因素,故认为对后穹隆有触痛结节、年龄小的EM患者,保守性手术术后应药物治疗,药物治疗推荐GnRHa类药物,应用疗程以6个月为宜。对于45岁以上患者保守性手术术后似乎不再需要为预防复发而联合药物治疗。对有生育要求者,术后可采取积极助孕措施。血清CA125在内异症Ⅰ-Ⅱ期的诊断价值较低,而对Ⅲ-Ⅳ期的内异症患者有一定诊断价值。对EM保守治疗后复发的患者治疗应慎重,对复发患者应用GnRHa可有效缓解盆腔症状,缩小异位囊肿包块,降低血清CA125值。EM患者行半根治性手术治疗时,行全子宫切除比次全子宫切除更有益处。根治性手术后复发率极低,若行HRT应严密随访。更多还原

【Abstract】 ObjectiveTo investigate recurrent rate of endometriosis and to analysis correlative factors and treatment of the patients of Affiliated Union Hospital of Fujian Medical University who have had endometriosis and who have been underwent surgery。MethodsA case control study. The clinical records of the patients who had endometriosis and who were underwent surgery from January 2002 to December 2006 were collected and sorted and then the patients were followed up. The data were analyzed by statistical software SPSS 13.0.Results1. One hundred and twelve patients of endometriosis were treated with conservative surgical treatment,22 cases of recurrence were found, 73 patients of endometriosis were treated with semi-radical surgery, 5 cases of recurrence were found,while 57 patients of endometriosis were treated with radical surgery, no cases of recurrence were found.The study shows that the recurrence rates of endometriosis were 19.6%,6.8%,0%,respectively, in patients after conservative surgery, semi-radical surgery, radical surgery.2. A total of 22 recurrences of endometriosis were found in conservative surgery group.The univariate, multivariate logistic regression analyses were performed to determine the predictive factors for recurrence of endometriosis.the related factors by univariate analysis were as follows: post-operative gravidity, post-operative adjuvant therapy, age, tenderness nodules at cul-de-sac, infertility(P<0.05).Meanwhile the related factors by multivariate logistic regression analysis were as follows: age(OR 0.863,P<0.05),post-operative gravidity(OR 0.115,P<0.05),post-operative adjuvant therapy (OR 1.344,P <0.05),tenderness nodules at cul-de-sac(OR 4.446,P<0.05).3. Levels of markers and the positive rate of serum CA125 were significantly higher in stageⅢ,Ⅳpatients than those in patients with stageⅠ,Ⅱdisease.4. Treatment of recurrence endometriosis with GnRH agonist three months has been shown to be useful in alleviating the symptoms, narrowing the ectopic mass, reduceding levels of serum CA125.Compared with those before treatment were statistically significant.5. The recurrence rate was 6.3% among the women who had hysterectomy versus 8.0%among those who had Subtotal hysterectomy. It was no statistical difference.6. There was no recurrence among the women who had hysterectomy and bilateral adnexectomy. It required further follow-up observation.ConclusionsThrough statistical analysis we found that related factors for recurrence of endometriosis were: tenderness nodules at cul-de-sac, post-operative gravidity, post- -operative adjuvant therapy,age,indicating those factors including cul-de-sac,post-oper -ative gravidity, post-operative adjuvant therapy, age, played an important role in relapse.The patients who were younger and had tenderness nodules at cul-de-sac should have drug therapy after conservative surgery.GnRH agonist were recommend.Application to six months course of treatment was appropriate. For patients older than 45 years appeared to be no longer necessary for medical treatment after conservative surgery.The patients who are required to have birth, the active treatment can be taken after surgery.The diagnostic value of serum CA125 in the cases of stageⅠ-Ⅱwas low,whereas serum CA125 in the cases of stageⅢ-Ⅳhas a certain diagnostic value.Treatment of endometriosis recurrence after conservative surgery should be carefully.Treatment with GnRH agonist has been shown to be useful in alleviating the symptoms, narrowing the ectopic mass, reducing levels of serum CA125.We suggested that TH should be performed in EM patients who had a plan to remove the uterus.The recurrent rate of EM after hysterectomy and bilateral adnexectomy was very low, but if HRT was indicated ,it should be monitored closely.更多还原