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目的探讨传统腹腔镜手术与保留神经的腹腔镜手术对深部浸润型子宫内膜异位症(DIE)患者的疗效以及并发症的差异,从而对两种手术方法的应用效果进行评价。方法选择73例DIE腹腔镜手术患者作为研究对象,根据手术方式不同分为观察组(37例)和对照组(36例),对照组患者采取传统手术,观察组患者采取保留盆腔自主神经的手术方法。记录两组患者术中和术后相关指标,并随访3个月进行VAS疼痛评分评价,观察两组患者膀胱功能、直肠功能以及性功能障碍等并发症的发生情况。结果两组患者手术时间、术中出血量、排气时间以及住院时间等术中和术后指标的差异均无统计学意义(P>0.05);随访3个月,两组患者VAS疼痛评分差异无统计学意义(P>0.05),但均较治疗前有显著下降,观察组患者膀胱功能障碍(1例,2.70%)、直肠功能障碍(2例,5.40%)和性功能障碍(1例,2.70%)发生率均低于对照组(分别为27.78%、30.56%和22.22%),差异有统计学意义(P<0.05)。结论保留神经的腹腔镜手术对治疗DIE是完全必要的,在不影响手术治疗效果的同时,又可有效减少膀胱功能、直肠功能以及性功能障碍等并发症发生,有利于改善患者的生活质量。
Objective To evaluate the efficacy and complications of laparoscopic surgery and nerve-preserving laparoscopic surgery in patients with deep infiltrative endometriosis (DIE) and to evaluate the effect of the two surgical methods. Methods Seventy-three patients with DIE underwent laparoscopic surgery were divided into the observation group (37 cases) and the control group (36 cases) according to different surgical methods. The patients in the control group were treated by conventional surgery. The patients in the observation group were treated with pelvic autonomic nerve preservation method. The indexes of intraoperative and postoperative were recorded in both groups. VAS pain score was evaluated after 3 months of follow-up. The complications such as bladder function, rectal function and sexual dysfunction were observed in two groups. Results There was no significant difference between the two groups in the intraoperative and postoperative indexes such as operation time, intraoperative blood loss, exhaust time and hospitalization time (P> 0.05). At the 3-month follow-up, VAS pain scores of the two groups were significantly different There was no significant difference between the two groups (P> 0.05), but both were significantly lower than those before treatment. The bladder dysfunction (1 case, 2.70%), rectal dysfunction (2 cases, 5.40%) and sexual dysfunction , 2.70%) were lower than the control group (27.78%, 30.56% and 22.22%, respectively), the difference was statistically significant (P <0.05). Conclusion Nerve laparoscopic surgery is completely necessary for the treatment of DIE. It can effectively reduce the complications such as bladder function, rectal function and sexual dysfunction without affecting the surgical treatment, which is beneficial to improve the quality of life of patients.