腹腔镜手术治疗子宫内膜异位症的疗效分析

Clinical efficacy of laparoscopic surgery for endometriosis

摘要:

目的 分析腹腔镜手术治疗子宫内膜异位症（EMS）患者的临床疗效。方法 选取2017年1月—2019年12月在海南医学院第一附属医院接受治疗的EMS患者94例，随机分为常规组、腔镜组，每组47例。常规组给予传统开腹手术治疗，腔镜组给予腹腔镜手术治疗；对比两组患者的围手术期指标、术后指标及术后并发症发生情况，随访24个月的复发率与妊娠成功率。结果 常规组与腔镜组手术时间比较，差异无统计学意义（P >0.05）。腔镜组术中出血量少于常规组（P <0.05），术后排气时间、住院时间短于常规组（P <0.05）。术后1 d两组血清CRP比较，差异无统计学意义（P >0.05）；腔镜组术后3 d两组血清CRP低于常规组。常规组与腔镜组6 h、12 h、24 h、48 h、72 h的VAS评分比较，采用重复测量设计的方差分析，结果 ①不同时间点VAS评分有差异（F =1 070.233，P =0.000）；②两组VAS评分有差异（F =1 701.139，P =0.000），腔镜组VAS评分较低，相对镇痛效果较好；③腔镜组与常规组VAS评分变化趋势有差异（F =59.125，P =0.000）。腔镜组术后并发症发生率低于常规组（P <0.05）。腔镜组与常规组复发率比较，差异无统计学意义（P >0.05）。腔镜组术后1年内和术后1～24个月的妊娠率高于常规组（P <0.05）。结论 腹腔镜手术治疗EMS疗效较好，能减轻术后炎症反应，降低并发症发生风险，提高术后妊娠率。

Abstract:

Objective To study the clinical efficacy of laparoscopic surgery for endometriosis (EMS).Methods A total of 94 EMS patients treated in The First Affiliated Hospital of Hainan Medical College from January 2017 to September 2018 were selected and randomly divided into routine group and laparoscopic group, respectively. The routine group was treated with open surgery, while the laparoscopic group was treated with laparoscopic surgery. The perioperative indicators, postoperative indicators and postoperative complications were compared between the two groups, and the recurrence rate and the successful pregnancy rate of the two groups were analyzed after 2 years of follow-up.Results There was no difference in the operative duration between the two groups (P > 0.05). The intraoperative blood loss in the laparoscopic group was less than that in the routine group (P < 0.05). The time to first flatus and the length of hospital stay in the laparoscopic group were shorter than those in the routine group (P < 0.05). There was no difference in the serum level of C-reactive protein (CRP) at 1 day after the surgery (P > 0.05), whereas the serum level of CRP at 3 days after the surgery was lower in the laparoscopic group than that in the routine group (P < 0.05). The Visual Analogue Scale (VAS) scores were compared between the two group at 6 h, 12 h, 24 h, 48 h, and 72 h, and the repeated-measures analysis of variance revealed that the VAS scores were different among the time points (F = 1,070.233, P < 0.05) and between the two groups (F = 1,701.139, P < 0.05). Compared with the routine group, the laparoscopic group had lower VAS scores and therefore better analgesic effects. Besides, the change trends of VAS scores were also different between the two groups (F = 59.125, P < 0.05). The overall incidence of postoperative complications in the laparoscopic group was lower than that in the routine group (P < 0.05). There was no difference in the recurrence rate between the two groups (P > 0.05). The pregnancy rates within 1 year and 2 years after the surgery in the laparoscopic group were both higher than those in the routine group (P < 0.05).Conclusions Laparoscopic surgery is effective for EMS patients. It ameliorates the postoperative inflammatory responses, reduces the risk of adverse events, and improves the postoperative pregnancy rates.