腹腔镜手术治疗深部浸润型子宫内膜异位症225例临床分析

doi:10.3877/cma.j.issn.1674-6899.2020.05.004

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (05) : 270 -273. doi: 10.3877/cma.j.issn.1674-6899.2020.05.004

所属专题：经典病例；总编推荐；经典病例；文献；

论著

腹腔镜手术治疗深部浸润型子宫内膜异位症225例临床分析

李震¹, 张妮娜¹, 王铭洋¹, 张小燕¹, 叶明侠¹, 顾成磊¹, 李立安¹, 孟元光¹^,^†(

)

^1. 100853　北京，解放军总医院第一医学中心妇产科

收稿日期:2020-08-20 出版日期:2020-10-30
通信作者: 孟元光

Clinical analysis of laparoscopic deep infiltrating endometriosis surgery in 225 cases

Zhen Li¹, Nina Zhang¹, Mingyang Wang¹, Xiaoyan Zhang¹, Mingxia Ye¹, Chenglei Gu¹, Lian Li¹, Yuanguang Meng¹^,^†()

^1. Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China

Received:2020-08-20 Published:2020-10-30
Corresponding author: Yuanguang Meng
About author:
Corresponding author: Meng Yuanguang, Email: meng6512@vip.sina.com

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目的

探讨腹腔镜手术治疗深部浸润型子宫内膜异位症(deep infiltrating endometriosis, DIE)的疗效。

方法

回顾性分析解放军总医院第一医学中心2008年1月至2018年7月共225例DIE患者，所有患者均接受彻底的腹腔镜子宫内膜异位病灶切除术并进行长期随访。统计患者的临床资料、围手术期参数、复发及自然受孕率等指标。

结果

225例患者中，178例(79.1%)患者有痛经症状，33例(14.7%)患者有性交痛，1例(0.4%)患者伴有便血，2例(0.9%)患者伴有血尿，8例(3.6%)患者伴有便秘，6例(2.7%)患者伴有腹泻，42例(18.7%)患者为无症状。平均术中出血量(94.4±191.6)ml，平均手术时间(85.5±51.0)min，平均住院时间(8.4±4.9)d 。并发症发生率：1.3%。随访时间1～144个月(中位随访时间57个月)，术后24个月复发率8.4%，术后60个月复发率16.4%，至随访截止总体复发率19.6%。自然受孕率67.5%。

结论

腹腔镜手术治疗DIE疗效满意。

关键词: 腹腔镜手术, 深部浸润型子宫内膜异位症

Objective

To discuss the efficacy of laparoscopic deep infiltrating endometriosis surgery.

Methods

Clinical data of 225 cases who underwent laparoscopic deep infiltrating endometriosis surgery in Chinese PLA General Hospital between Jan. 2008 and Jul. 2018 were analyzed retrospectively. Clinical features, perioperative outcomes, recurrence and natural conception rate were analyzed.

Results

Among the 225 cases, 178 cases(79.1%) had dysmenorrhea, 33 cases (14.7%)had dyspareunia, 1 case(0.4%) had hematochezia, 2 cases (0.9%)had hematuresis, 8 cases (3.6%)had constipation, 6 cases (2.7%)had diarrhea, 42 cases (18.7%)had no symptom. Average blood loss was(94.4±191.6) ml, average operative time was (85.5±51.0) min, average hospital stay was (8.4±4.9) d. Complication rate was 1.3%. Follow up period ranged from 1-144 months(Median follow-up time 57 months ), 24 months recurrence rate was 8.4%, 60 months recurrence rate was 16.4%, overall recurrence rate was 19.6%. Natural conception rate was 67.5%.

Conclusions

Laparoscopic deep infiltrating endometriosis surgery is safe and effective for deep infiltrating endometriosis.

Key words: Laparoscopic surgery, Deep infiltrating endometriosis

图1 直肠、骶韧带深部浸润型子宫内膜异位症的手术步骤

图2 深部浸润型子宫内膜异位症患者术后复发情况生存分析

图3 游离输尿管的方法

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