摘要
目的:评价腹腔镜病灶切除术治疗累及阴道后穹窿深部浸润型子宫内膜异位症(deeply infiltrating endom etriosis,DIE)的可行性和有效性。方法:回顾分析2005年4月到2007年4月北京协和医院妇产科行手术治疗并经病理证实侵犯阴道后穹窿DIE患者14例的临床资料。患者均经腹腔镜切除盆腔所有内膜异位症(内异症)病灶及受累的部分阴道壁。手术治疗的有效性通过患者的视觉模拟评分(visual analog scale,VAS)和症状改善的主观感觉(改善显著、满意和无改善)。结果:患者平均年龄35.0±5.7岁(26～45岁)。14例手术指征均为盆腔疼痛,包括痛经(13/14),性交痛(7/14),慢性盆腔痛(3/14),6例合并不育。未发生术中并发症,平均随诊22.0±8.4月(12～36月)。13例痛经患者中,除1例术后20天出现阴道出血,在外地医院行阴道填塞止血无效后行全子宫切除术,不计入痛经改善评价外,手术后痛经的VAS评分均明显下降(6.2±3.1vs0.8±1.4)(P<0.001),4例痛经症状改善显著(33.3%),8例改善满意(66.7%)。7例性交痛患者中,5例症状改善显著,2例改善满意。慢性盆腔痛3例患者症状均改善显著。6例(42.9%)不孕患者中术后3例妊娠。13例患者症状和体征均无复发。结论:腹腔镜切除侵及阴道后穹窿的DIE病灶可有效缓解疼痛症状,手术应由有经验的医生完成,治疗的安全性和远期有效性的评价需进一步扩大研究样本。
Objeetive ： To evaluate the feasibility and efficacy of of deeply infiltrating endometriotic lesions （DIE） with posterior vaginal laparoscopic excision fomix involvement. Methods：Fourteen cases of DIE with posterior vaginal fomix involvement were included in this retrospective study. Laparoseopic surgery was performed with in-block resection of pelvic endometriotie lesions, opening and partial excision of the posterior vaginal fornix and vaginal closure. Results：The mean age of the patients was（ 35.0±5.7 ）years （range ：26 -45 years）. All patients had painful symptoms. No intra-operative complications were observed. The mean follow up time was （22.0 ±8.4） monthes （ range ： 12 - 36 months）. One patient had severe vaginal bleeding on the 20th day after operation and hysterectomy was done, the case was not included in the dysmenorrhea improvement evaluation. The mean visual analog scale （VAS） score of dysmenorrhea was significantly lower postoperatively （6.2 ±3.1 vs 0.8 ±1.4 ） （ P 〈 0.001 ）. The dysmenoIThea improvement was considered to be excellent in 33.3% of eases（4/12）, satisfactory in 66.7% of cases （8/12）. The dyspareunia improvement was considered to be excellent in 5 cases（5/7 ）, satisfactory in 2 cases （2/7）. The noneyclie chronic pelvic pain improvement was considered to be excellent in all 3 cases. Among 6 infertile cases（42.9% ） ,3 women achieved pregnancy after surgery. During mean follow up of 22 months, all 13 cases had no recurrence of symptom and sign. Conclusion： Laparoscopic excision of DIE with posterior vaginal fornix excision was feasible and can effectively relieve pain symptoms. However, large randomized controlled studies would be required to validate this approach.
出处
《现代妇产科进展》
CSCD
北大核心
2009年第4期286-288,292,共4页
Progress in Obstetrics and Gynecology
关键词
深部浸润型子宫内膜异位症
阴道后穹窿
腹腔镜外科手术
治疗结果
Deeply infiltrating endometriosis
Posterior vaginal fornix
Laparoscopic surgical preocedures
Treatment outcome
