两种保守性手术治疗子宫腺肌病的近远期疗效分析

摘要

目的:探讨经腹病灶切除术及子宫动脉栓塞术(UAE)两种保守性手术治疗子宫腺肌病的近、远期疗效.方法:选择因子宫腺肌病住院行经腹病灶切除术(A组97例)及UAE(B组89例),随访至术后48个月,资料完整的患者.比较两组术后痛经缓解、Hb水平、子宫体积大小、安全性、总治疗费用等.结果:A、B两组术后6个月痛经缓解率分别为93.3％、91.6％,48个月为76.7％、73.5％;两组与术前比较痛经均明显缓解(P＜0.05),组间术后各时段比较,差异均无统计学意义(P＞0.05).A、B两组术后6个月Hb分别为102.7±26.0g/L、99.6±17.4 g/L,48个月分别为121.6±13.8 g/L、117.4±14.2g/L;与术前比较Hb均明显升高(P＜0.05),组间术后各时段比较,差异均无统计学意义(P＞0.05).两组术后子宫体积与术前比较明显缩小(P＜0.05);A组子宫体积缩小更明显,组间术后各时段比较,差异均有统计学意义(P＜0.05).两组患者术前CA125平均值升高,术后6个月A、B两组CA125降至正常的分别有90例、78例.两组患者术中及术后随访未见严重并发症;术后性激素水平无明显改变.术后受孕时间A组长于B组.B组费用明显高于A组.结论:两种手术治疗子宫腺肌病均有较好的近远期疗效,且安全性好.经腹病灶切除术费用低,具较好的性价比;UAE微创,则为术后短期内有生育要求的患者提供了可能.%Objective:To assess the short and long term curative effects of adenomyomectomy and uterine artery embolisation (UAE) in treatment of adenomyosis (AM). Methods: Women undergoing adenomyo-mectomy( group A 97 cases) and undergoing UAE (group B 89cases) were followed up to 48 months after operations. The degree of dysmenorrheal,level of hemoglobin,uterine volume,and security after two operations were compared and analyzed between these two groups. Resluts: The symptom of dysnenorrhea: the rates of dysnenorrhea in group A and group B were 93. 3% ,91. 6%respectively,and effective rates were in 76. 7% (69/90), 73. 5% (61/83) respectively,the difference was not statistically significant ( P>0. 05). The level of hemoglobin;the level of hemoglobin 6 months after operations in group A and group B were 102. 7 ± 26. 0 g/L、99. 6 ± 17. 4 g/L,respectively,48 months after operations were 121. 6 ± 13. 8 g/L、117. 4 ± 14.2 g/L respectively. There was obvious raise about hemoglobin when compared to preoperation ( P < 0. 05). There was no statistically significant between two groups after operation (P>0. 05). The uterine volume was obvious smaller after operation in two groups(P<0. 05) ,especially in group A. There was obvious statistical different after operation in two groups in different time( P<0. 05). The level of CA125 was raised before operation. 6 months after operation,there were 90 and 78 cases with normal level of CA125 in two groups. There were no severe complications in two groups during follow up and no changes of sex hormone. The time of pregnancy after operation in group A was longer than group B. The cost in group B was obviously higher than rngroup A. Conclusions:Both adenomyomectomy and UAE are effective and safe surgical approaches for the patients with AM. Adenomyomectomy has good cost performance. UAE makes it possible for the patients desired pregnancy to conceive shortly after the operation.