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目的探讨腹腔镜下病灶切除术联合醋酸亮丙瑞林治疗子宫腺肌病的疗效。方法选择重度痛经或月经改变并强烈要求保留子宫的子宫腺肌病患者47例,分别行腹腔镜下病灶切除术(腹腔镜组,24例)和手术联合醋酸亮丙瑞林4个月(联合组,23例)治疗。比较两组患者的痛经、月经量及子宫大小。结果术后6个月,腹腔镜组患者痛经缓解率(91.3%,21/23)与联合组(95.7%,22/23)比较,差异无统计学意义(P>0.05);腹腔镜组子宫体积[(133.1±28.4)cm3]与联合组[(114.2±31.1)cm3]比较,差异有统计学意义(P<0.05);腹腔镜组月经量减少率(73.9%,17/23)与联合组(100%,23/23)比较,差异有统计学意义(P<0.05)。术后12个月,两组痛经缓解率(65.2%,15/23;95.5%,21/22)、月经量减少率(52.2%,12/23;81.8%,18/22)和子宫体积[(132.3±27.5)cm3,(116.7±25.5)cm3]比较,差异均有统计学意义(P<0.05)。两组患者均无并发症发生。结论腹腔镜下子宫腺肌病病灶切除术联合醋酸亮丙瑞林治疗子宫腺肌病是一种安全、有效缓解痛经,减少月经量的方法。
Objective To investigate the efficacy of laparoscopic resection combined with leuprolide in the treatment of adenomyosis. Methods Forty-seven patients with severe dysmenorrhoea or menstrual changes who were strongly required to retain uterine adenomyosis were treated with laparoscopic resection (laparoscopic group, 24 cases) and surgery combined with leuprolide (4 months) Group, 23 cases) treatment. Dysmenorrhea, menstrual flow and uterine size were compared between the two groups. Results There was no significant difference in the rate of dysmenorrhea (91.3%, 21/23) between the laparoscopic group and the combined group (95.7%, 22/23) at 6 months after operation (P> 0.05) (133.1 ± 28.4) cm3] and the combined group (114.2 ± 31.1 cm3), the difference was statistically significant (P <0.05). The reduction rate of menstrual flow in laparoscopic group (73.9%, 17/23) Group (100%, 23/23), the difference was statistically significant (P <0.05). At 12 months after operation, the rates of dysmenorrhea (65.2%, 15/23; 95.5%, 21/22), menstrual flow reduction (52.2%, 12/23; 81.8%, 18/22) and uterine volume (132.3 ± 27.5) cm3, (116.7 ± 25.5) cm3], the difference was statistically significant (P <0.05). No complications occurred in both groups. Conclusion Laparoscopic adenomyosis resection combined with leuprolide acetate in the treatment of adenomyosis is a safe and effective way to relieve dysmenorrhea and reduce menstrual flow.