首页|深部浸润型子宫内膜异位症与非深部浸润型患者的临床特征与远期预后对比

深部浸润型子宫内膜异位症与非深部浸润型患者的临床特征与远期预后对比

Comparison of clinical characteristics and long-term prognosis between patients with deep infiltrating endometriosis and those without deep infiltrating endometriosis

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目的 对比分析深部浸润型子宫内膜异位症(DIE)与非深部浸润型患者的临床特征与远期预后.方法 对2016年1月至2018年1月北部战区总医院收治的行腹腔镜手术治疗的178例子宫内膜异位症患者资料进行回顾性分析,其中95例DIE患者作为观察组,83例非深部浸润型患者作为对照组,两组术后均获至少5年随访.对两组的一般临床资料、术中及术后随访资料做统计分析.结果 与对照组比较,观察组的年龄明显更大[(33.8±5.5)岁vs(32.0±5.2)岁],中重度痛经[72.6%(69/95)vs 55.4%(46/83)]、慢性盆腔痛[24.2%(23/95)vs 8.4%(7/83)]、血糖类抗原(CA)125升高[80.0%(76/95)vs 65.1%(54/83)]的比例均更多,视觉模拟量表(VAS)评分亦更高[(5.4±1.2)分 vs(4.3±0.9)分],同时手术时间更长[(75.1±20.1)min vs(56.0±18.9)min]、患者术中出血量也更多[(79.2±23.0)ml vs(57.8±16.3)min],双侧囊肿[54.7%(52/95)vs 34.9%(29/83)]、严重盆腔粘连[90.5%(86/95)vs 53.0%(44/83)]、合并子宫腺肌病[41.1%(39/95)vs 22.9%(19/83)]比例更高,美国生育学会修订子宫内膜异位症分期标准(rAFS)评分更高[(61.8± 22.1)分 vs(39.4±19.1)分]且 rAFS 分期Ⅳ期[71.6%(68/95)vs 43.4%(36/83)]比例更多,术后用药比例更高[98.9%(94/95)vs 92.8%(7/83)],上述指标两组比较差异均有统计意义(均P<0.05 或 P<0.01).观察组、对照组的复发率[21.1%(20/95)vs 15.7%(13/83)]、活产率[100%(35/35)vs 92.1%(35/38)]比较,差异均无统计意义(均P>0.05).结论 相对非DIE患者,DIE患者疼痛症状及盆腔粘连程度更重,rAFS评分更高且Ⅳ期比例更多,但术后复发率未见差异,同时对生育结局也无显著影响.
Objective To compare and analyze the clinical characteristics and long-term prognosis of patients with deep infiltrating endometriosis(DIE)and non deep infiltrating endometriosis.Methods A retrospective analysis was conducted on the data of 178 patients with endometriosis who underwent laparoscopic surgery at the General Hospital of Northern Theater Command from January 2016 to January 2018.Among them,95 patients with DIE were treated as the observation group,and 83 patients with non deep infiltration were treated as the control group.Both groups were followed up for at least 5 years after surgery.Perform statistical analysis on the general clinical data,intraoperative and postoperative follow-up data of the two groups.Results Compared with the control group,the observation group had significantly older age[(33.8±5.5)years vs(32.0±5.2)years],moderate to severe dysmenorrhea[72.6%(69/95)vs 55.4%(46/83)],chronic pelvic pain[24.2%(23/95)vs 8.4%(7/83)],higher proportion of elevated blood carbohydrate antigen 125(CA125)[80.0%(76/95)vs 65.1%(54/83)],and higher Visual Analogue Scale(VAS)[(5.4±1.2)points vs(4.3±0.9)points];At the same time,the surgery time was longer[(75.1±20.1)min vs(56.0±18.9)min],the patient's intraoperative bleeding was also greater[(79.2±23.0)ml vs(57.8±16.3)min],bilateral cysts[54.7%(52/95)vs 34.9%(29/83)],severe pelvic adhesions[90.5%(86/95)vs 53.0%(44/83)],and the proportion of concurrent adenomyosis[41.1%(39/95)vs 22.9%(19/83)]was higher,with higher Revised American Fertility Society(rAFS)scores[(61.8±22.1)vs(39.4±19.1)].The proportion of rAFS stage Ⅳ[71.6%(68/95)vs 43.4%(36/83)]was higher,and the proportion of postoperative medication was higher[98.9%(94/95)vs 92.8%(7/83)].The above indicators showed statistically significant differences between the two groups(all P<0.05 or P<0.01).There was no statistically significant difference in the recurrence rate[21.1%(20/95)vs 15.7%(13/83)]and live birth rate[100%(35/35)vs 92.1%(35/38)]between the observation group and the control group(all P>0.05).Conclusions Compared to non DIE patients,DIE patients have more severe pain symptoms and pelvic adhesions,higher rAFS scores,and a higher proportion of stage.Ⅳ.However,there was no significant difference in postoperative recurrence rate,and there was no significant impact on fertility outcomes.

Deep infiltrating endometriosisLaparoscopy

宋秀玲、陈静

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北部战区总医院妇产科,沈阳 110016

深部浸润型子宫内膜异位症 腹腔镜检查

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(1)
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