【作者】 刘晓敏；

【导师】 刘爱民；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 目的：通过分析卵巢子宫内膜异位症患者的临床特点和术式比较，从而探讨血清CA125与AFS分期的关系，手术方式的选择：LS（腹腔镜手术）与AS（开腹手术）相关指标的比较，总结诊治卵巢子宫内膜异位症的临床经验。方法：选取2011年1月至2012年1月期间在我院妇外科行卵巢子宫内膜异位囊肿剥除术与附件切除术治疗并经术后病理检查证实为卵巢子宫内膜异位症的患者580例，对其进行回顾性分析，临床指标包括患者年龄、临床症状、囊肿直径及侧别、血清CA125水平、AFS分期、手术方式及手术相关指标（手术时间、术中出血量、术后体温恢复时间、排气时间、住院天数）。所得结果应用SPSS3.0统计分析软件进行分析，相关性比较采用u检验、X~2检验，P<0.05为差异有统计学意义。结果：①年龄：580例患者年龄16-53岁，平均35岁高峰年龄在21-45岁。②临床症状：有症状患者为434例(74.8%)，无症状的患者为146例(25.2%)，主要临床表现发生率由高到低为：月经异常改变，痛经、不规律腹痛、不孕。③囊肿情况：左侧为209例(36.%)，右侧为180例(31%)，双侧为191例(32.9%)；囊肿直径分为四组：2-5cm为295例(50.8%)，6-10cm为266例(45.8%)，11-15cm为10例(1.7%)，16-26cm为9例(1.6%)。囊肿直径主要10cm之内。④CA125：有CA125检查结果者为365例，结果正常者为285例(78.1%)；异常者分为三组：35-100（包括35、100）U/ml为64例(17.5%)；100-200（包括200）U/ml为14例(3.8%)，200-320（最高为320）U/ml为2例(0.5%)。AFS分期Ⅰ期中CA125正常者49例(87.5%)，35-100U/ml为6例(10.9%)，100-200（包括200）U/ml为1(1.8%)例；AFS分期Ⅱ期中CA125正常64例(83.1%)，35-100U/ml为11例(14.3%)，100-200（包括200）U/ml为2例(2.6%)；AFS分期Ⅲ期CA125正常者115例(79.3%)，35-100U/ml者22例(15.2%)，100-200（包括200）U/ml为7例(4.8%)，200-320U/ml为1例；AFS分期Ⅳ期CA125正常57例(65.5%)，35-100U/ml为25例(28.7%)，100-200（包括200）U/ml为4例(4.6%)，200-320U/ml为1例(1.1%)。⑤手术治疗方法：本临床分析主要纳入LS囊肿剥除术、LS附件切除术、AS囊肿剥除术、AS附件切除术四种，不同年龄段的患者术式选择不同：16-20岁组行LS囊肿剥除术者占51.9%，21-35岁组LS囊肿剥除术占58.9%，AS囊肿剥除术占40.7%,36-45岁组LS囊肿剥除术占36.2%，AS囊肿剥除术占57.4%；46-53岁组LS囊肿剥除术14.8%，AS囊肿剥除术68.5%。囊肿直径2-5cm组LS囊肿剥除术所占本组51.9%，全部LS囊肿剥除术的58.2%，LS囊肿剥除术比例较大，6-10cm组LS囊肿剥除术所占本组40.6%，全部LS囊肿剥除术的41.1%，AS囊肿剥除术所占比例大。11-15cm组AS囊肿剥除术占本组70%，全部AS囊肿剥除术的2.4%，AS附件切除术占本组10%，AS囊肿剥除术比例较大，AS附件切除术比例开始增大。16-26cm组AS囊肿剥除术占本组66.7%，全部AS囊肿剥除术的2.1%，AS附件切除术占本组33.3%，AS囊肿剥除术比例较大，附件切除术比略增大，但仍低于囊肿剥除术。CA125值正常者：LS囊肿剥除术142例(49.8%)，AS囊肿剥除术130例(45.6%)，LS附件切除术0例，AS附件切除术13例(4.5%)；35-100U/ml组LS囊肿剥除术23例(35.9%)，AS囊肿剥除术36例(56.2%)，LS附件切除术1例(1.6%)，AS附件切除术3例(4.7%)，100-200（包括200）U/ml组LS囊肿剥除术7例(50%)，AS囊肿剥除术6例(42.8)，LS附件切除术0例，AS附件切除术1例(7.1%)。200-320U/ml组LS囊肿剥除术1例(50%)，AS囊肿剥除术为0例，LS附件切除术0例，AS附件切除术1例(50%)。⑥LS和AS术中及术后相关指标的对比：与AS相比较，LS时间短，术中出血少，术后恢复快，住院时间短，但术后发热时间比开腹组长。结论：卵巢子宫内膜异位症多发生于21-45岁的育龄妇女；1/4患者无明显临床症状，常见临床表现发生率依次为：月经异常改变、痛经、不规律腹痛、不孕；左、右、双侧发病无明显差异，囊肿多数直径小于10cm；查血CA125最恰当时机为患者卵泡期，其值与AFS分期有相关性，呈正相关，AFS分期越高，CA125值及阳性率越高；各组均首选保守性囊肿剥除术，患者年龄影响手术方式选择；囊种大小、CA125与腹腔镜或开腹选择有相关性，与附件切除或囊肿剥除无相关性；腹腔镜具有创伤小，手术时间短，术中出血少，术后恢复快，住院时间短等优点，但Ⅳ期LS术后发热时间比AS组时间久，应注意电凝的正确使用。更多还原

【Abstract】 Objective: To investigate the correlation between serum CA125and AFSstaging, selections of surgical approaches and comparison of related indicationsbetween LS (laparoscopic surgery) and AS (laparotomy) through analyzingclinical features and surgical approaches of patients with endometriosis.Methods:580patients underwent ovarian endometriosis cystectomy andappendectomy in the department of Gynecology which were pathologicallyconfirmed as ovarian endometriosis after operation were included in the study.Retrospective analysis of ages, cyst diameter and location of side, serumCA125, AFS staging, surgical approaches and related factors (operationduration, blood loss, postoperative temperature recovery time, exhaust time,days of hospitalization) were carried out, comparison of the data acquired wereexamined by u test and X~2test with the statistical analysis software ofSPSS13.0, and P<0.05were identified as statistically significant．Results:①Age: The ages of the580patients ranged from16to53withthe mean age of35. the peak of age is between21-45.②The group weredivided into two main groups by Clinical manifestation:146cases (25.2%)were asymptomatic and434cases were symptomatic with the main clinicalmanifestations of: menstrual abnormalities216cases (42%), dysmenorrheal171cases (33%), irregular abdominal pain111cases (21%) and infertility21cases (4%).③Cyst: The Cyst were divided in to three groups by direction:Left209cases (36%), right180cases (31%), bilateral191cases (32.9%); TheCyst were divided in to four groups by diameter:2-5cm295cases (50.8%),6-10cm266cases (45.8),11-15cm10cases,16-26cm9cases (1.5%). Patientsmainly distributed in the group of less than10cm.④The group were dividedinto two main groups by CA125:365cases’ results were available in which285 cases (78.1%) were normal. Abnormal cases were divided in to three groups:35-100U/ml64cases (17.5%),100-200(including200) U/ml14cases (3.8%)and>200U/ml2cases (0.5%). In the group of AFS Ⅰ49cases (87.5%) hadnormal CA125while35-100U/ml6cases (10.9%),100-200(including200)U/ml1case (1.8%); in the group of AFSⅡ64cases (83.1%) had normalCA125while35-100U/ml11cases (14.3%),100-200(including200) U/ml2cases (2.6%); in the group of AFS Ⅲ115cases (79.3%) had normal CA125while35-100U/ml22cases (15.2%),100-200(including200) U/ml7case(4.8%),200-320U/ml1case (1.1%); and in the group of AFS Ⅳ57cases(65.5%) had normal CA125while35-100U/ml25cases (28.7%),100-200(including200) U/ml4case (4.6%),200-320U/ml1case (1.1%).⑤Surgicalapproaches: Four surgical approaches including LS cystectomy, LS annexresection, AS cystectomy and AS adnexectomy were mainly included in thisclinical analysis and were selected according to the ages: LS cystectomy,accounting for51.86%, was mainly selected for the patients of20years old andbelow, LS cystectomy accounted for58.9%in the group of21-35while AScystectomy accounted for40.7%, in the group of36-45LS cystectomyaccounted for36.2%and AS cystectomy accounted for57.4%, the group of46years old and above consisted of14.81%of AS cystectomy and68.5%of AScystectomy. Grouped by the cyst diameter, patients with cyst diameter2-5cmwho underwent the operation of LS cystectomy accounted for51.8%of it’sgroup and58.2%of all the cases underwent LS cystectomy, which was a largeproportion. In the group of6-10cm LS cystectomy accounted for40.6%of it’sgroup and41.1%of all the cases underwent laparoscopic cystectomy, in thegroup of11-15cm AS cystectomy accounted for70%of it’s group and2.4%ofall the cases underwent AS cystectomy while AS accounted for10%. In thegroup of which diameter16-26cm, AS cystectomy accounted for66.7%of it’sgroup and2.1%of all the cases underwent this approach while AS adnexectomy accounted for33.3%of this group. In the grouped of patients hadnormal CA125, the number of cases underwent LS cystectomy, AS cystectomy,LS adnexectomy and AS adnexectomy were142(49.8%),130(45.6%),0and13(4.6%), respectively; In the group of patients whose serum CA125is35-100U/ml, the numbers of patients who underwent the four above mentionedapproaches were23(35.9%),36(56.2%),1(1.56%) and13(4.6%),respectively; In the group of CA125100-200(including200) U/ml the numberswere7(50%),6(42.8%),0and1(7.1%), and in the group ofCA125200-320U/ml the numbers were1(50%),0,0and1(50%).⑥Intraoperative and postoperative comparison of the relevant indicators betweenLS and AS: LS had shorter operation duration, less blood loss, quicker recovery,shorter hospital stay but longer duration of fever when compared to the AS,especially in those AFS Ⅳ, LS have longer period of thermoregulationrecovery.Conclusion: Ovarian endometriosis was of age-related, which mainlyinvolve childbearing women within21-45years old;1/4patients wereasymptomatic, the clinical manifestation were abnormal menstruation,dysmenorrhea, irregular abdominal pain and infertility; No significantdifference was found among the location of left, right and bilateral side; Mostcyst had the diameter of less than10cm; CA125should be best tested in thepatients with follicular phase and had relevance to the AFS staging, it’s leveland positive ratio increased correspond to the AFS staging; Cystectomy wasmore commonly used regardless of age, AS and semiconservative surgery weremore commonly used as the age increased. Selection between LS and ASaffected by the diameter of the cyst and the level of CA125, but it is not withthe selection between cystectomy and adnexectomy.更多还原