摘要
目的观察子宫腺肌瘤患者行单孔腹腔镜联合超声引导微波消融术治疗的近期疗效,探讨其安全性。方法2020年4月—2021年12月河南省人民医院诊治子宫腺肌瘤患者15例(合并肠粘连5例,盆腔粘连3例,输卵管系膜囊肿2例,卵巢囊肿2例,深部浸润性子宫内膜异位症2例),均行单孔腹腔镜联合超声引导微波消融术,记录手术情况,术后并发症发生情况。比较术前及术后3、6、12个月子宫、腺肌瘤体积,血红蛋白、糖类抗原125(CA125)水平及视觉模拟评分(VAS)评分。术后随访,评价治疗效果。结果(1)15例手术均顺利,术中生命体征平稳,术后子宫造影提示消融完全,腺肌瘤内均无血流信号、瘤体均无强化。术后均未发生肠道、膀胱等周围脏器损伤的严重并发症;术后发生下腹痛、阴道排液>10 d各1例,均经对症处理后缓解。(2)术后3、6、12个月子宫体积[100.07(50.00,188.70)、69.26(45.21,157.22)、68.99(36.90,135.39)cm^(3)]、子宫腺肌瘤体积[26.56(18.78,48.60)、22.66(2.62,30.07)、13.63(0.35,26.56)cm3]均小于术前[165.45(94.08,244.66)、47.00(27.90,96.98)cm^(3)](P<0.05)。(3)术后6、12个月血红蛋白[(125.30±3.13)、(131.50±3.40)g/L]水平均高于术前[(103.40±5.66)g/L](P<0.05),术后3、6、12个月CA125[(23.38±4.25)、(10.27±0.86)、(7.72±0.76)u/mL]、VAS评分[(5.47±0.52)、(2.40±0.58)、(1.80±0.61)分]均低于术前[(85.82±21.74)u/mL、(8.13±0.54)分](P<0.05)。(4)术后3个月评定疗效,疗效非常显著8例,显著3例,有效3例,无效1例,总有效率为93%。结论单孔腹腔镜联合超声引导微波消融术可缩小子宫腺肌瘤患者子宫体积、腺肌瘤体积,减轻疼痛,纠正贫血,降低CA125水平。
Objective To observe the short-term outcome of single-port laparoscopic and ultrasound-guided microwave ablation for uterine adenomyoma,and to investigate its safety.Methods Fifteen patients with uterine adenomyoma(combined with intestinal adhesions in 5 cases,pelvic adhesions in 3 cases,tubal mesenchymal cysts in 2 cases,ovarian cysts in 2 cases,and deep infiltrating endometriosis in 2 cases)were performed single-port laparoscopic and ultrasound-guided microwave ablation in Henan Provincial People's Hospital from April 2020 to December 2021.The surgical conditions and the occurrence of postoperative complications were recorded.The uterine volume,adenomyoma volume,hemoglobin,carbohydrate antigen 125(CA125)and visual analogue scale(VAS)score were compared preoperatively and in 3,6 and 12 months postoperatively.The patients were followed up to evaluate the surgical effect.Results(1)All 15 cases underwent surgery smoothly,with stable vital signs during operation.Hysterography after operation showed complete ablation,no blood flow signal in the adenomyoma,and no enhancement of the tumor body.No serious postoperative complications occurred such as damage to the intestinal tract,bladder and other peripheral organs.The mild complications as postoperative lower abdominal pain in 1 case and vaginal discharge for>10 d in 1 case,were relieved after symptomatic treatment.(2)The uterine volumes in 3,6 and 12 months after operation[100.07(50.00,188.70),69.26(45.21,157.22),68.99(36.90,135,39)cm~3]and adenomyoma volumes[26.56(18.78,48.60),22.66(2.62.30.07),13.63(0.35,26.56)cm^(3)]were smaller than those before operation[165.45(94.08,244.66),47.00(27.90,96.98)cm^(3)](P<0.05).(3)The hemoglobin level was higher in 6 months after operation[(125.30±3.13)g/L]and 12 months after operation[(131.50±3.40)g/L]than that before operation[(103.40±5.66)g/L](P<0.05),and CA125 and VAS score were lower in 3 months after operation[(23.38±4.25)u/mL,5.47±0.52],6 months after operation[(10.27±0.86)u/mL,2.4±0.58]and 12 months after operation[(7
作者
应瑞琼
和晓利
贾琳琳
段少博
李睿
YING Ruiqiong;HE Xiaoli;JIA Linlin;DUAN Shaobo;LI Rui(Department of Gynecology,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Department of Gynecology,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Ultrasound,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2023年第9期943-947,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
2020年度留学人员科研择优项目(豫人社办函[2020]70号)
河南省医学科技攻关计划联合共建项目(LHGJ20200024)。
关键词
子宫腺肌瘤
微波消融术
单孔腹腔镜
超声造影
uterine adenomyoma
microwave ablation
single-port laparoscopy
contrast-enhanced ultrasound
