摘要目的 探讨1983-2009年北京协和医院子宫内膜异位症(内异症)手术治疗的特点及发展趋势.方法 通过查阅1983年1月至2009年6月于本院就诊、经手术证实为内异症的病例,比较不同手术方式(开腹手术和腹腔镜手术)、不同手术类型(保守性手术、根治或半根治性手术)的例数及构成差异,分析手术方式及手术类型的变化趋势.结果 资料完整的内异症手术病例共13 972例,占同期所有妇科手术的24.974%(13 972/55 945).其中,腹腔镜手术占内异症手术的59.490%(8312/13 972),显著高于腹腔镜手术在其他疾病相关手术中所占比例[37.700%(15 824/41 973),P<0.01];2005-2009年,内异症腹腔镜手术所占比例上升至68.23%(947/1388),显著高于2000-2004年[56.04%(510/910),P<0.01].盆腔内异症手术中,保留子宫及卵巢的保守性手术占64.014%(8663/13 533);2005-2009年,保守性手术所占的比例上升至66.24%(4176/6304).在盆腔内异症保守性手术及根治或半根治性手术中,腹腔镜手术所占的比例存在显著差异[分别为81.10%(7026/8663)和26.30%(1281/4870),P<0.01].与1983-1999年及2000-2004年比较,2005-2009年内异症手术的年平均手术例数、腹腔镜手术的年平均手术例数及其在内异症手术中所占比例、保守性手术的年平均手术例数及其在盆腔内异症手术中所占比例均显著升高(P均<0.01).内异症相关手术的严重并发症发生率为0.351%(49/13 972).结论 内异症手术治疗是本院妇科手术的重要构成,保守性手术是内异症主要的手术类型,而腹腔镜是主要的手术方式.

abstractsObjective To investigate the characteristics and trends of surgical management on endometriosis in Peking Union Medical College Hospital From 1983 to 2009. Methods The medical documents of patients with endometriosis diagnosed by surgical pathology were studied retrospectively in Peking Union Medical College Hospital (PUMCH). The ratio of different surgical approaches (laparoscopic and laparotomic surgery) and surgical categories (conservative, semi-radical or radical surgery) were compared in all the cases with endometriosis to investigated alterations trends of approaches and methods of surgery. Results Totally integrated records of 13 972 patients underwent surgeries on endometriosis were reviewed and consisted of 24. 974% (13 972/55 945) of all gynecologic surgeries. 59. 490% of cases (8312/13 972) were treated by laparoscopic approach, which were significantly higher than the rate of 37.700%(15 824/41 973) of laparoscopic approaches in the other gynecologic diseases (P<0.01). The proportion of laparoscopic surgeries in all endometriosis surgery was 67.31% (947/1407) between 2005 and 2009, which were significantly higher than 55. 98% (510/911) of laparoscopic surgeries between 2000 and 2004 (P<0.01). Conservative surgery (i.e.,with uterus and ovaries intact) consisted of 64. 014%(8663/13 533) of endometriosis surgeries. The proportion of conservative surgeries was 66. 24% (4176/6304) between 2005 and 2009. The proportion of laparoscopic approaches consisted of 81.10% (7026/8663) of conservative surgeries and 26. 30% (1281/4870) of semi-radical or radical surgeries (P<0.01).The average number of annual surgeries, the average number of annual laparoscopic surgeries and its proportion in endometriosis, and the average number of annual conservative surgeries and its proportion in pelvic endometriosis between 2005 -2009 were all increased significantly than those at range of 1983 to 1999 and 2000 to 2004. The rate of severe complication 0. 351% (49/13 972) was observed in all endometriosis surgeries. Conclusion Surgery was the major treatment of endometriosis in PUMCH, laparoscopic surgery was the major approach and conservative surgery was the major surgery type.