子宫大部分切除术治疗子宫腺肌病临床研究.doc

子宫大部分切除术治疗子宫腺肌病临床研究 　　[摘要] 目的 探讨年轻的子宫腺肌病患者(≤40岁)保留子宫的手术方式。方法 通过对78例子宫腺肌病病人进行荷包式缝合法子宫大部分切除子宫成形术(观察组),并选择同期因子宫腺肌病入院行全子宫切除术60例(对照组),比较术后患者对性生活评价。结果 观察组术后性生活改善有效率为97.4%,对照组有效率为80.0%,差异有统计学意义(P0.01)。结论 荷包式缝合法子宫大部切除术后子宫成形术,手术方法简单,止血效果可靠,重新成形的子宫能够保留子宫部分内膜和子宫动脉上行支,痛经完全缓解或基本缓解,术后仍有少量月经,保留宫颈及阴道穹窿部,明显改善及提高夫妻双方性生活满意度。 　　[关键词] 子宫内膜异位症; 子宫内膜; 子宫切除术; 痛经 　　[中图分类号] R713.4+2;R711.71 [文献标识码] A [文章编号] 1673-9701(2010)03-126-02 　　 　　Large Partial Excision of Uterine Body for Adenomyosis 　　ZHANG Wenying WANG Xiaoping LI Ping 　　Department of Gynecology,Pingdu City People’s Hospital,Pingdu266700,China 　　 　　[Abstract] ObjectiveTo investigate surgical methods of reserving partial uterus in young patients(≤40 years)with adenomyosis. Methods Seventy-eight patients of the study group received large partial excision of uterine body and metroplasty by purse-string suture, and 60 patients of the control group received total hysterectomy. Postoperative sexual life was evaluated in the two groups. ResultsThere was a significant improvement of sexual life in the study group compared with the control group(97.4% versus 80.0%,P0.01). ConclusionThe large partial excision of uterine body and metroplasty by purse-string suture is an effective and safe therapy for adenomyosis,which may completely or partly release dysmenorrhoea and significantly improve the satisfaction of sexual life due to reserving partial endometrium,the ascending branches of uterine artery, cervix and vaginal fornix. 　　[Key words]Endometriosis; Endomtrium; Hysterectomy; Dysmenorrhea 　　 　　子宫腺肌病是一种以痛经和月经量过多、子宫不规则出血为主要症状的妇科常见病,近年来其发病率呈上升的趋势,发病年龄降低,≤40岁的病人手术治疗常常希望保留子宫。我们应用荷包式缝合法子宫大部分切除后子宫成形术,治疗年轻患者的子宫腺肌病,取得较满意效果。 　　1 资料与方法 　　1.1 病例选择 　　2005年11月～2009年2月入住我院的子宫腺肌病患者78例,子宫大于孕10周大小,无生育要求但要求保留子宫者,知情同意后选择此术式,平均年龄(36±0.56)岁,为观察组;对照组60例为同期因子宫腺肌病入院行子宫全子宫切除术者,平均年龄(38±0.32)岁。 　　1.2 手术前准备 　　(1)病人准备:月经干净后1周内。(2)手术前检查:①血常规、血生化、肝肾功能等的检测;②进行宫颈细胞学检查,以排除宫颈恶性病变;③填写痛经评价量表及性生活评价量表。 　　1.3 手术方法 　　(1)手术要点:①沿子宫角部内侧切除大部分子宫体及子宫内膜;②切除病变组织及多余子宫肌层,保