Objective To investigate the effect of modified laparoscopic-assisted vaginal hysterectomy ( LAVH) in treatment of obese patients with deep infiltrating endometriosis ( DIE) combined with uterine gland muscle disease. Methods A total of 114 obese patients with DIE combined with uterine gland muscle disease underwent ectopic focus re-section and total hysterectomy during January 2003 and January 2013 by one surgeon, and 48 patients ( group A) under-went modified LAVH, while the other 66 patients ( group B) underwent laparotomy. The intraoperative and postoperative recovery, and the effect of surgical treatment and the symptom improvement 6 month after the operation in the two groups were observed. Results In group A, 1 patient was converted to undergo the laparotomy due to highly dense adhesions induced by uterine rectum septum formation, and 45 patients underwent complete resection of uterus and DIE lesions un-der the laparoscopes, and 2 patients reserved part DIE lesions;4 patients reserved part DIE lesions in group B. Com-pared with those in group B, the volume of intraoperative bleeding was less, and postoperative anal exhaust time and hos-pitalization stay was shorter, and the postoperative disease rate was lower in group A, and the differences were statistically significant ( P <0. 05 or P <0. 01 ) . With postoperative follow-up for 6 months, the scores of visual analogue score (VAS) were decreased in the two groups (P<0. 01), but the difference of symptom improvement in the two groups was not statistically significant (P>0. 05). In the two groups, residual tumor lesions did not continue to increase, and com-plete excision of lesions was no recurrence, and no related complications was found. Conclusion The modified LAVH operation in treatment of obese patients with IDE combined with uterine gland muscle disease may improve the operative safety with little intraoperative bleeding, quick postoperative recovery and good recent curative effect.%目的 探讨改良腹腔镜辅助阴式子宫切除术( laparoscopic-assisted vaginal hysterectomy, LAVH)治疗深部浸润型子宫内膜异位症( deep infiltrating endometriosis, DIE)合并子宫腺肌症肥胖患者的效果. 方法 选择我院2003年1月-2013年1月由同一术者行异位灶切除加全子宫切除的DIE合并子宫腺肌症肥胖患者114例,其中行改良LAVH术48例,开腹手术66例. 观察两组术中及术后恢复情况,以及术后半年手术治疗效果和症状改善情况. 结果 腹腔镜组1例因子宫直肠隔形成严重致密粘连而中转开腹,45例镜下完整切除子宫及DIE病灶,2例残留部分DIE病灶;开腹组4例DIE病灶残留. 腹腔镜组术中出血量少于开腹组,术后肛门排气时间、住院时间短于开腹组,术后病率低于开腹组,差异均有统计学意义(P<0. 05或P<0. 01);术后半年随访两组视觉模拟评分(VAS)均降低(P<0. 01),但两组症状改善情况比较差异无统计学意义(P>0. 05);两组残余病灶者病灶未继续增大,完整切除病灶者均无复发,均未发生手术相关并发症. 结论 改良LAVH术治疗IDE合并子宫腺肌症肥胖患者提高了手术安全性,术中出血少,术后恢复快,近期疗效显著.
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