切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (05): 277 -280. doi: 10.3877/cma.j.issn.1674-6899.2018.05.005

所属专题： 文献资源库；

论著 上一篇    下一篇

子宫动脉阻断对腹腔镜腺肌病灶切除长期疗效的价值
彭燕蓁 1, 段华 1 , †( ), 郭银树 1, 成九梅 1, 臧春逸 1, 王金娟 1   
  1. 1. 100006 北京，首都医科大学附属北京妇产医院妇科微创中心
  • 收稿日期:2018-08-26 出版日期:2018-10-30
  • 通信作者: 段华
  • 基金资助:
    北京市医管局临床医学发展专项(ZY201406)

Clinical value of uterine artery occlusion in long-term effecs of laparoscopic adenomyomectomy

Yanzhen Peng 1, Hua Duan 1 , †( ), Yinshu Guo 1, Jiumei Cheng 1, Chunyi Zang 1, Jinjuan Wang 1   

  1. 1. Center of Minimally Iinvasive Gynecological Surgery of Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University, Beijing 100006, China
  • Received:2018-08-26 Published:2018-10-30
  • Corresponding author: Hua Duan
  • About author:
    Corresponding author: Duan Hua, Email:
全文 ( ) 下载PDF ( )
目的

研究子宫动脉阻断(uterine artery occlusion，UAO)对腹腔镜子宫腺肌病灶切除术长期疗效的临床应用价值。

方法

采用前瞻性队列研究方法，选取2010年1月至2015年1月在首都医科大学附属北京妇产医院妇科微创中心行腹腔镜子宫腺肌病灶切除术的102例患者为研究对象，其中行腹腔镜子宫腺肌病灶切除联合UAO 68例(研究组)，单纯腹腔镜子宫腺肌病灶切除34例(对照组)，分析比较两组的手术时间、术中出血量、手术前后血红蛋白变化、术后最高体温、术后痛经评分、经量评分及复发率。

结果

与对照组相比，研究组术中出血量明显减少[(120.30±121.20)ml vs(176.00±149.25)ml]，差异有统计学意义(P<0.05)；两组手术时间、手术前后血红蛋白变化、术后住院时间均无明显差异(P>0.05)；术后3年，两组的复发率(20.6% vs 23.5%)、痛经评分[(2.69±1.04)分vs(2.78±1.27)分]、经量评分[(1.24±0.45)分vs (1.38±0.30)分]均无显著差异(P>0.05)。

结论

UAO可以减少腹腔镜子宫腺肌病灶切除术中出血，但对此手术远期疗效无明显改善作用。

关键词: 腹腔镜子宫腺肌病灶切除, 子宫动脉阻断, 复发率
Objective

Investigate the clinical application value of uterine artery occlusion in long-term effects of laparoscopic adenomyectomy.

Methods

A prospective cohort study of patients undergoing laparoscopic adenomyectomy combided with artery occlusion(study group, n=68) was carried out in Beijing Obstetrics and Gynecology Hospital from Jan. 2010 to Jan.2015. 34 patients undergoing simple laparoscopic adenomyectomy in the same period was selected as the control group. For the comparision of the two groups, the operation duration, blood loss during operation, postoperative maximum temperature, the length of postoperative hospitalization, postoperative hemoglobin change, postoperative dysmenorrhea score, menstrual score and recurrence rate were observed.

Results

Compared with control group, the patients of study group show significant less blood loss during operation [(120.30±121.20)ml vs(176.00±149.25)ml] (P<0.05). There was no significant difference in the operation duration, blood loss during operation, postoperative maximum temperature, postoperative hemoglobin change between the two groups (P> 0.05). There was no significant difference in recurrence rate (20.6% vs 23.5%), menstrual score[(1.24±0.45) vs(1.38±0.30)] and dysmenorrhea score[(2.69±1.04) vs(2.78±1.27)] between two groups three years after operation.

Conclusions

Uterine artery occlusion are effective on reducing blood loss during operation, but it may be unuseful in improving long-term clinical outcomes of laparoscopic adenomyectomy.

Key words: Laparoscopic adenomyomectomy, Uterine artery occlusion, Recurrence rate
表1 两组腹腔镜子宫腺肌病灶切除术患者的基线情况比较( ±s)
组别 例数 年龄(岁) 孕次(次) 产次(次) VAS评分(分) 月经评分(分) 子宫体积(cm3) 最大腺肌瘤直径(cm) 术前血红蛋白(g/L)
研究组 68 40.34±3.43 2.19±1.50 1.01±0.30 8.06±1.99 1.67±1.57 224.65±100.56 5.89±1.34 109.21±11.44
对照组 34 41.40±3.52 2.17±1.45 0.90±0.39 7.90±1.87 1.98±1.70 198.88±99.80 5.70±1.66 110.67±18.97
F值 ? 3.94 1.92 0.10 0.86 0.69 1.49 0.70 0.69
P值 ? 0.05 0.17 0.76 0.36 0.42 0.25 0.79 0.411
表2 两组腹腔镜子宫腺肌病灶切除术患者的围手术期情况( ±s)
组别 例数 手术时间(min) 术中出血量(ml) 术后最高体温(℃) 手术前后血红蛋白变化(mg/L) 术后住院时间(d)
研究组 68 103.10±84.82 120.30±121.20 37.72±0.45 10.25±11.53 5.58±1.43
对照组 34 107.21±34.87 176.00±149.25 37.87±0.50 17.00±19.18 6.00±1.08
F值 ? 0.16 4.78 0.56 4.23 1.71
P值 ? 0.70 0.03 0.34 0.04 0.19
表3 两组腹腔镜子宫腺肌病灶切除术患者的长期疗效比较
组别 例数 VAS评分(分， ±s) 月经评分(分， ±s) 复发[例(%)] 复发时间(月， ±s)
研究组 68 2.69±1.04 1.24±0.45 14(20.6) 12.86±2.42
对照组 34 2.78±1.27 1.38±0.30 8(23.5) 13.82±2.24
F值 ? 1.08 1.62 0.30 0.08
P值 ? 0.30 0.21 0.56 0.78
1
Thain S, Tan HH. Approaches to adenomyomectomy[J]. Gynecology and Minimally Invasive Therapy，2015，4(3):49-54.
2
Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis[J]. Fertility and Sterility，2014，101(2):472-487.
3
Kwack J, Kwon Y. Laparoscopic surgery for focal adenomyosis[J]. JSLS : Journal of the Society of Laparoendoscopic Surgeons，2017，21(2):2014-2017.
4
Chong GO, Lee YH, Hong DG, et al. Long-term efficacy of laparoscopic or robotic adenomyomectomy with or without medical treatment for severely symptomatic adenomyosis[J]. Gynecologic and Obstetric Investigation，2016，81(4):346-352.
5
Huang X, Huang Q, Chen S, et al. Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis[J]. BMC Women's Health, 2015，15(1):24-24.
6
Yang W, Liu M, Liu L, et al. Uterine-sparing laparoscopic pelvic plexus ablation, uterine artery occlusion, and partial adenomyomectomy for adenomyosis[J]. Journal of Minimally Invasive Gynecology，2017，24(6):940-945.
7
Kwon Y, Roh HJ, Ahn JW, et al. Conservative adenomyomectomy with transient occlusion of uterine arteries for diffuse uterine adenomyosis[J]. Journal of Obstetrics and Gynaecology Research，2015，41(6):938-945.
8
Liu M, Cheng Z, Dai H, et al. Long-term efficacy and quality of life associated with laparoscopic bilateral uterine artery occlusion plus partial resection of symptomatic adenomyosis[J]. Eur J Obstet Gynecol Reprod Biol，2014，176(1):20-24.
9
Wang PH, Liu WM, Fuh JL, et al. Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma[J]. Fertil Steril，2009，92(3):876-885.
10
郭银树，段华. 微创技术保守性治疗子宫腺肌病的现状与进展[J]. 中国微创外科杂志，2016，16(2):181-184.
11
霍智锋，段慧，陈春林，等. 子宫动脉栓塞术治疗子宫腺肌病痛经疗效评判时间点的研究[J]. 中国微创外科杂志，2015，15(5):421-424.
12
Shui L, Mao S, Wu Q, et al. High-intensity focused ultrasound (HIFU) for adenomyosis: two-year follow-up results[J]. Ultrason Sonochem，2015，27(3):677-681.
13
Younes G, Tulandi T. Conservative surgery for adenomyosis and results: a systematic review[J]. J Minim Invasive Gynecol，2018，25(2):265-276.
14
马荣丽，关铮. 子宫腺肌病保守性手术的应用及研究进展[J]. 国际妇产科学杂志，2014，41(6):628-631.
15
彭燕蓁，段华，郭银树，等. 开腹与腹腔镜子宫腺肌病灶切除术的临床比较[J/CD]. 中华腔镜外科杂志(电子版)，2016，9(6):362-365.
16
Chen L, Li C, Guo J, et al. Eutopic/ectopic endometrial apoptosis initiated by bilateral uterine artery occlusion: a new therapeutic mechanism for uterus-sparing surgery in adenomyosis[J]. PLOS ONE，2017，12(4):175511-175511.
17
Yang W, Cheng Z, Yu J, et al. Multicentre study to evaluate the clinical effects of laparoscopic uterine artery occlusion in combination with myomectomy to treat symptomatic uterine leiomyomas[J]. European Journal of Obstetrics & Gynecology and Reproductive Biology，2016，204(1):9-15.
18
Bae JH, Chong GO, Seong WJ, et al. Benefit of uterine artery ligation in laparoscopic myomectomy[J]. Fertil Steril，2011，95(2):775-778.
[1] 欧阳振波. 腹腔镜下子宫动脉阻断在子宫肌瘤治疗中的研究进展[J]. 中华妇幼临床医学杂志(电子版), 2013, 09(02): 246-249.
[2] 金红梅. 腹腔镜辅助阴式子宫肌瘤剔除术中3种止血方法的疗效分析[J]. 中华妇幼临床医学杂志(电子版), 2012, 08(04): 461-463.
[3] 张美英. 腹腔镜经腹腹膜前疝修补术对腹股沟疝患者术后恢复、凝血功能及男性性功能的影响[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(03): 228-232.
[4] 邹春霞, 陈燕子, 薛璟, 吴永祥. 急诊绿色通道护理对创伤性膈疝患者救治成功率的影响[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(05): 552-555.
[5] 朱林榆, 张瑜, 冷少龙. 经同侧腹直肌易位造口在腹腔镜造口旁疝修补术中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(05): 452-455.
[6] 高倩闽, 陈昕涛, 姚厚山, 胡志前. 进展期直肠癌新辅助放化疗研究进展[J]. 中华结直肠疾病电子杂志, 2020, 09(02): 188-195.
[7] 王斌, 刘圣, 刘兴龙, 祖庆泉, 赵林波, 施海彬. 介入栓塞治疗难治性鼻出血的疗效分析[J]. 中华介入放射学电子杂志, 2018, 06(01): 14-17.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号