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目的 探讨子宫肌腺病保守手术在改善症状、增加妊娠几率方面的效果。方法 为 2 6例有生育要求的子宫肌腺病患者施行子宫肌腺瘤剔除术或子宫肌腺病部分病灶切除术。患者平均年龄 35 .8岁 ,以痛经、经血过多为主要症状。已婚患者中 ,原发不孕 7例 ( 31 .8% ) ,继发不孕 1 0例 ( 45 .5 % ) ,习惯性流产 3例 ( 1 3.6 % )。结果 子宫肌腺瘤组 1 0例 ,病灶均挖除干净。弥漫性子宫肌腺病组 1 6例 ,均仅作大部病灶切除 ,未能切净。术前 2 2例有痛经的患者 ,术后痛经消失或明显减轻 ,术后重度痛经发生率明显低于术前 ( P<0 .0 0 1 )。术前 1 7例经血过多患者 ,术后仅 4例仍有经血过多症状 ( P<0 .0 0 1 )。术后子宫肌腺瘤组 7例有生育要求的患者中 5例共妊娠 9次 ,5次足月生产 ;弥漫性子宫肌腺病组 1 4例有生育要求的患者中 3例妊娠 3次 ,1例足月生产 ,子宫肌腺瘤组术后妊娠及足月生产率明显高于弥漫性子宫肌腺病组 ( P=0 .0 3,P=0 .0 2 )。2 6例患者中 3例复发 ,平均复发时间 49.6个月。结论 子宫肌腺瘤保守手术可以明显地改善症状、增加妊娠几率 ,故能够被年轻、有生育要求的患者所接受。弥漫性子宫肌腺病保守手术妊娠率较低 ,然仍有一定的治疗价值。
Objective To investigate the effect of conservative surgery on adenomyosis in improving symptoms and increasing the chance of pregnancy. Methods 26 cases of infertility patients with adenomyosis uterine adenomyosis or uterine adenomyosis partial resection. The average age of patients 35.8 years old, with dysmenorrhea, menstrual bleeding as the main symptom. Among the married patients, 7 cases (31.8%) were primary infertility, 10 cases (45.5%) were secondary infertility and 3 (13.6%) were habitual abortion. Results 10 cases of uterine muscle adenomas, lesions were dig clean. 16 cases of diffuse uterine adenomyosis, were only for the majority of lesions removed, failed to cut net. Preoperative 22 cases of dysmenorrhea patients, postoperative dysmenorrhea disappeared or significantly reduced the incidence of postoperative severe dysmenorrhea was significantly lower than preoperative (P lt; 0 01). In the preoperative 17 cases of excessive menstrual bleeding, only 4 cases still had excessive menstrual bleeding (P <0.01). Among the 7 patients with postoperative uterine muscular adenomas who had fertility requirements, 5 were pregnant with 9 total pregnancies and 5 full-term births. Of the 14 patients with diffuse uterine muscular adenosis who had fertility requirements, 3 were pregnant 3 times, One case of full-term production, uterine muscle adenomas postoperative pregnancy and full-term productivity was significantly higher than diffuse uterine adenomyosis group (P = 0.30, P = 0. 02). Three of the 26 patients relapsed, with an average recurrence of 49.6 months. Conclusions Conservative surgical treatment of uterine adenoma can significantly improve the symptoms and increase the chance of pregnancy, so it can be accepted by young and fertile patients. Diffuse uterine adenomyosis conservative surgery lower pregnancy rate, there are still some therapeutic value.