叶茵

[摘要]目的 探讨腹腔镜手术和开腹手术治疗子宫内膜异位症伴不孕患者的效果。方法 选取2014年6月～2016年6月在我院行手术治疗的子宫内膜异位症伴不孕患者58例作为研究对象，按随机数字表法分为对照组（29例）和观察组（29例）。对照组予以开腹手术，观察组采用腹腔镜手术。观察两组手术时间、术中出血量、术后排气时间、下床活动时间、住院时间以及治疗总有效率。术后随访1年，记录患者妊娠情况。结果 观察组的手术时间、排气时间、下床活动时间以及住院时间均显著短于对照组，术中出血量显著少于对照组，差异均有统计学意义（P<0.01）。观察组治疗有效率显著高于对照组，差异有统计学意义（P<0.01）。观察组1年妊娠率显著高于对照组，差异有统计学意义（P<0.01）。结论 腹腔镜手术治疗子宫内膜异位症伴不孕损伤小、出血量少，恢复快、临床效果显著、妊娠率高，同时安全有效。

[关键词]子宫内膜异位症；不孕；腹腔镜手术；开腹手术

[中图分类号] R711.71 [文献标识码] A [文章编号] 1674-4721（2018）7（b）-0085-03

[Abstract] Objective To explore the effect of laparoscopy and laparotomy in the patients with endometriosis with infertility. Methods A total of 58 endometriosis with infertility patients from June 2014 to June 2016 in our hospital with surgical treatment for endometriosis were selected as research objects， and were divided into control group （29 cases） and observation group （29 cases） according to random number table method. The patients in the control group were operated on laparotomy， and the patients in the observation group were operated on laparoscopy. The operation time， the amount of bleeding in the operation， the time of postoperative exhaust， the time of the ambulation， the time of hospitalization and the effective rate of treatment were observed in the two groups. The patients were followed up for 1 years， and the pregnancy was recorded. Results The operative time， exhaust time， ambulation time and hospitalization time in the observation group were significantly shorter than those in the control group. The intraoperative blood loss in the observation group was significantly lesser than that in the control group. The differences between the two groups were statistically significant （P<0.01）. The effective rate of the observation group after laparoscopy was significantly higher than that of the control group， and the difference was statistically significant （P<0.01）. The 1 year pregnancy rate of the observation group was significantly higher than that of the control group， and the difference was statistically significant （P<0.01）. Conclusion Laparoscopic surgery for endometriosis with infertile has the advantages of less bleeding， rapid recovery， significant clinical effect， high pregnancy rate， safe and effective at the same time.

[Key words] Endometriosis； Infertility； Laparoscopy； Laparotomy

子宮内膜异位症（Endometriosis，EMs）是育龄妇女常见的妇科疾病[1]，因具有生长功能的子宫内膜细胞种植生长于子宫腔被覆内膜及宫体肌层以外的不正常的位置而引起的雌激素依赖性疾病。EMs通常临床表现为盆腔痛、性交痛、痛经、月经异常及不孕[2]，虽不对生命造成影响，但严重影响女性身心健康，生活质量及家庭和谐[3]。相关研究发现，EMs与不孕症间的关系较为密切[4]，大约50%的EMs患者可合并不孕[5]。EMs伴不孕是因为输卵管与周围组织粘连而影响排卵，导致女性发生不孕，故临床治疗的主要目的是恢复输卵管、卵巢间的正常解剖关系，清除内异病灶和腹腔液，减轻对生殖功能的影响，因此基于上述目的探索一种安全有效的治疗手段，对存在生育要求的女性而言意义重大。……