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目的探讨手术治疗卵巢内膜样囊肿痛经及不孕的作用及卵巢内膜样囊肿有别于其他类型子宫内膜异位症(内异症)的临床特征。方法回顾性分析复旦大学附属妇产科医院2003年1月至2004年12月收治的850例卵巢内膜样囊肿患者的临床资料及随访结果。结果712例完成随访(随访率83.76%)。其中主诉为痛经316例(44.38%),不孕42例(5.90%),盆腔肿块294例(41.29%),痛经合并不孕60例(8.43%)。术后痛经症状缓解率为87.23%(328/376)。COX多因素回归分析示r-AFS分期与术后痛经症状复发相关(P<0.05),而不同手术方式(保守性、半根治性手术)及术后是否加用促性腺激素释放激素类似物(GnRHa)治疗对痛经复发无明显影响(P>0.05)。102例合并不孕者均行保守性手术治疗,总的术后妊娠率为37.25%(38/102),其中继发不孕者高于原发不孕(53.33%对30.56%,P<0.05)。r-AFS分期与术后GnRHa治疗对术后妊娠率无影响(P>0.05)。结论(1)对卵巢内膜样囊肿患者而言,手术治疗可缓解痛经症状,但手术方式并不能影响症状的改善,痛经复发与分期有关。(2)保守性手术可增加不孕者术后妊娠率,继发不孕者疗效优于原发不孕,术后加用GnRHa治疗并不提高术后妊娠率。
Objective To investigate the effect of surgical treatment of dysmenorrhea and infertility in ovarian endometrioid cysts and the clinical features of ovarian endometrioid cysts different from other types of endometriosis (endometriosis). Methods The clinical data and follow-up results of 850 patients with ovarian endometrioid cyst admitted to the Obstetrics and Gynecology Hospital of Fudan University from January 2003 to December 2004 were retrospectively analyzed. Results 712 cases were followed up (follow-up rate was 83.76%). The main complaints were dysmenorrhea in 316 cases (44.38%), infertility in 42 cases (5.90%), pelvic mass in 294 cases (41.29%) and dysmenorrhea in 60 cases (8.43%). Postoperative dysmenorrhea symptom relief rate was 87.23% (328/376). COX multivariate regression analysis showed that r-AFS staging correlated with postoperative dysmenorrhea recurrence (P <0.05), but different surgical methods (conservative, semi-radical surgery) and postoperative gonadotropin-releasing hormone analogues GnRHa) had no significant effect on the recurrence of dysmenorrhea (P> 0.05). The 102 cases of combined infertility were performed conservative surgery, the total postoperative pregnancy rate was 37.25% (38/102), of which secondary infertility were higher than the primary infertility (53.33% vs 30.56%, P <0.05 ). The r-AFS stage and postoperative GnRHa treatment had no effect on postoperative pregnancy rate (P> 0.05). Conclusion (1) For patients with ovarian endometrioid cyst, surgical treatment can alleviate the symptoms of dysmenorrhea, but the surgical approach does not affect the improvement of symptoms, dysmenorrhea recurrence and staging. (2) Conservative surgery can increase the postoperative pregnancy rate of infertility, secondary infertility is better than the primary infertility, postoperative GnRHa treatment does not increase the rate of postoperative pregnancy.