中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
8期
603-607
,共5页
子宫内膜异位症%腹腔镜检查%戈舍瑞林%治疗结果
子宮內膜異位癥%腹腔鏡檢查%戈捨瑞林%治療結果
자궁내막이위증%복강경검사%과사서림%치료결과
Endometriosis%Laparoscopy%Goserelin%Treatment outcome
目的 探讨腹腔镜保守性手术联合戈舍瑞林(其他名称:诺雷得)治疗重度卵巢内异症的近远期疗效.方法 回顾性分析2004年1月至2008年12月就诊于南京大学医学院附属鼓楼医院的206例经腹腔镜手术与病理检查确诊的重度卵巢内异症患者的临床资料,根据美国生育学会1985年修订的内异症分期标准(r-AFS)进行分期,其中Ⅲ期患者123例(59.7％)、Ⅳ期患者83例(40.3％)；伴有盆腔疼痛者138例.均实施腹腔镜下卵巢内异症囊肿剔除术,对其中117例有生育要求的患者同时行宫腔镜检查及输卵管插管通液术(其中因输卵管病变切除双侧输卵管7例,双侧输卵管梗阻2例,有生育功能者108例),术后给予戈舍瑞林3.6 mg/28 d,3～6个月.术后随访1 ～5年,观察术后盆腔疼痛、妊娠、复发情况；并分析影响术后妊娠和复发的相关因素.结果 (1)盆腔疼痛:术后1～5年盆腔疼痛完全缓解率为76.1％ (105/138).(2)妊娠:术后1～5年共有76例患者妊娠,总妊娠率为70.4％ (76/108),其中自然妊娠率为68.8％( 66/96)；体外受精-胚胎移植(IVF-ET)后妊娠率为10/12.1年自然妊娠率为57.3％ (55/96),在5年中占83.3％( 55/66)；妊娠结局:自然妊娠活产率为86.4％ (57/66)；IVF-ET妊娠活产率为9/10.(3)复发:术后1～5年总复发率为8.3(17/206).术后第1年的复发率为3.9％ (8/206),术后复发率与累积复发率第2年分别为2.0％(3/149)、6.7％( 10/149)；第3年分别为1.0％( 1/99)、8.0％( 8/99)；第4年分别为10.9％ (5/46)、17.4％ (8/46)；第5年分别为0、2/18.结论 腹腔镜保守性手术后联合戈舍瑞林药物治疗,对重度卵巢内异症患者提高妊娠率、降低复发率有重要作用.
目的 探討腹腔鏡保守性手術聯閤戈捨瑞林(其他名稱:諾雷得)治療重度卵巢內異癥的近遠期療效.方法 迴顧性分析2004年1月至2008年12月就診于南京大學醫學院附屬鼓樓醫院的206例經腹腔鏡手術與病理檢查確診的重度卵巢內異癥患者的臨床資料,根據美國生育學會1985年脩訂的內異癥分期標準(r-AFS)進行分期,其中Ⅲ期患者123例(59.7％)、Ⅳ期患者83例(40.3％)；伴有盆腔疼痛者138例.均實施腹腔鏡下卵巢內異癥囊腫剔除術,對其中117例有生育要求的患者同時行宮腔鏡檢查及輸卵管插管通液術(其中因輸卵管病變切除雙側輸卵管7例,雙側輸卵管梗阻2例,有生育功能者108例),術後給予戈捨瑞林3.6 mg/28 d,3～6箇月.術後隨訪1 ～5年,觀察術後盆腔疼痛、妊娠、複髮情況；併分析影響術後妊娠和複髮的相關因素.結果 (1)盆腔疼痛:術後1～5年盆腔疼痛完全緩解率為76.1％ (105/138).(2)妊娠:術後1～5年共有76例患者妊娠,總妊娠率為70.4％ (76/108),其中自然妊娠率為68.8％( 66/96)；體外受精-胚胎移植(IVF-ET)後妊娠率為10/12.1年自然妊娠率為57.3％ (55/96),在5年中佔83.3％( 55/66)；妊娠結跼:自然妊娠活產率為86.4％ (57/66)；IVF-ET妊娠活產率為9/10.(3)複髮:術後1～5年總複髮率為8.3(17/206).術後第1年的複髮率為3.9％ (8/206),術後複髮率與纍積複髮率第2年分彆為2.0％(3/149)、6.7％( 10/149)；第3年分彆為1.0％( 1/99)、8.0％( 8/99)；第4年分彆為10.9％ (5/46)、17.4％ (8/46)；第5年分彆為0、2/18.結論 腹腔鏡保守性手術後聯閤戈捨瑞林藥物治療,對重度卵巢內異癥患者提高妊娠率、降低複髮率有重要作用.
목적 탐토복강경보수성수술연합과사서림(기타명칭:낙뢰득)치료중도란소내이증적근원기료효.방법 회고성분석2004년1월지2008년12월취진우남경대학의학원부속고루의원적206례경복강경수술여병리검사학진적중도란소내이증환자적림상자료,근거미국생육학회1985년수정적내이증분기표준(r-AFS)진행분기,기중Ⅲ기환자123례(59.7％)、Ⅳ기환자83례(40.3％)；반유분강동통자138례.균실시복강경하란소내이증낭종척제술,대기중117례유생육요구적환자동시행궁강경검사급수란관삽관통액술(기중인수란관병변절제쌍측수란관7례,쌍측수란관경조2례,유생육공능자108례),술후급여과사서림3.6 mg/28 d,3～6개월.술후수방1 ～5년,관찰술후분강동통、임신、복발정황；병분석영향술후임신화복발적상관인소.결과 (1)분강동통:술후1～5년분강동통완전완해솔위76.1％ (105/138).(2)임신:술후1～5년공유76례환자임신,총임신솔위70.4％ (76/108),기중자연임신솔위68.8％( 66/96)；체외수정-배태이식(IVF-ET)후임신솔위10/12.1년자연임신솔위57.3％ (55/96),재5년중점83.3％( 55/66)；임신결국:자연임신활산솔위86.4％ (57/66)；IVF-ET임신활산솔위9/10.(3)복발:술후1～5년총복발솔위8.3(17/206).술후제1년적복발솔위3.9％ (8/206),술후복발솔여루적복발솔제2년분별위2.0％(3/149)、6.7％( 10/149)；제3년분별위1.0％( 1/99)、8.0％( 8/99)；제4년분별위10.9％ (5/46)、17.4％ (8/46)；제5년분별위0、2/18.결론 복강경보수성수술후연합과사서림약물치료,대중도란소내이증환자제고임신솔、강저복발솔유중요작용.
Objective To evaluate the short-term and long-term efficacy of conservative laparoscopic surgery combine with goserelin in treatment of severe ovarian endometriosis.Methods From January 2004 to December 2008,206 patients with severe ovarian endometriosis underwent laparoscopy surgery in Nanjing Drum Tower Hospital,Affiliated Nanjing University Medical School were enrolled in this retrospective study.According to the revised classification American Fertility Society (r-AFS), 123( 123/206,59.7％ ) cases were at stage Ⅲ and 83 ( 83/206,40.3％ ) patients were at stage Ⅳ.Among 138 cases presented pelvic pain.All the patients underwent laparoscopic cystectomy,of which 117 patients with childbearing preserving underwent hysteroscopy and hydrotubation examination,including 7 cases with bilateral salpingectomy,2 cases with bilateral tubal obstruction and 108 cases with normal reproduction.After surgery,all cases were administered by goserelin treatment at dose of 3.6 mg per 28 days for 3 to 6 months.At 1 to 5 years following up,pelvic pain,pregnancy and recurrence were observed,those factors associated with pregnancy rate and endometriosis recurrence were analyzed.Results (1)Pelvic pain:complete remission rate of pelvic pain was 76.1％ ( 105/138 ) at 1 to 5 years after surgery.(2) Pregnancy:total pregnancy rate was 70.4％ (76/108),spontaneous pregnancy rate was 68.8％ (66/96) and pregnant rate of in vitro fertilization and embryo transfer (IVF-ET) was 10/12.Pregnancy rate at 1 year was 57.3％( 55/96 ) and accounting for 83.3％ ( 55/66 ) in all pregnant womon.Live birth rates of spontaneous pregnant and IVF-ET were 86.4％ ( 57/66 ) and 9/10,respectively.( 3 ) Recurrence:the total recurrence rate was 8.3％ ( 17/206 ) at 1 to 5 years.The recurrence rates and the cumulative recurrence rates were 3.9％(8/206) and 3.9％ (8/206) at the first year after operation,2.0％ (3/149)and 6.7％ ( 10/149 )at the second year,1.0％ (1/99) and 8.0％ (8/99) at the third year,10.9％ (5/46)and 17.4％ (8/46) at the fourth year,0 and 2/18 at the fifth year,respectively.Conclusion It was suggested that conservative laparoscopic surgery combined with goserelin in treatment of stage Ⅲ or Ⅳ ovarian endometriosis could reduce the recurrence risk of severe ovarian endometriosis and improve the pregnant rate of endometriosisassociated infertility.
