卵巢子宫内膜异位囊肿手术后地诺孕素辅助治疗效果及其安全性

Efficacy and safety of dinorgestrel adjuvant therapy of patients after the operation of ovarian endometriosis cyst

目的:卵巢子宫内膜异位囊肿(OMA)腹腔镜保守手术后应用地诺孕素(DNG)或促性腺激素释放激素激动剂(GnRHa)疗效、复发、妊娠及并发症对比。方法:收集本院2021年4月-2022年4月收治的行腹腔镜下剥除术OMA患者90例,随机数表法分为两组。术后对照组采取GnRHa治疗,观察组采取DNG治疗,均随访12个月。对比分析两组临床资料,肿瘤标志物及卵巢功能指标水平,复发及不良反应等,并对复发因素进行回归分析。结果:随访12个月时,两组卵巢功能指标血清卵泡刺激素、黄体生素素、雌二醇及抗缪勒管激素均下降,且对照组下降幅度大于观察组;雌二醇水平在术后第1个月对照组即降低至20pg/ml以下,通过反向添加替勃龙半颗或1颗维持治疗,对照组雌二醇水平下降时间早于观察组;术后6个月、12个月时两组生活质量评分均上升且观察组(87.35±4.47分、92.14±4.51分)高于对照组(72.46±4.22分、78.26±4.48分),两组疼痛VAS评分均下降,且观察组(0.58±0.81分、1.49±1.25分)均低于对照组(1.74±2.03分、2.91±1.62分)(均P<0.05)。术后12个月时复发率对照组(4.4%)与观察组(11.1%)无差异,妊娠率对照组(36.4%)与观察组(57.7%)无差异(P>0.05);不良反应发生率对照组(75.6%)高于观察组(31.1%)(P<0.05)。结论:OMA剥除术术后应用GnRHa、DNG辅助治疗均能有效改善患者术后复发、疼痛及不良反应等,与GnRHa相比,DNG更适合应用于OMA患者的术后长期管理。

Objective:To compare the efficacy,recurrence and complications of the adjuvant treatment with gonadotro-pinreleasing hormone agonist(GnRHa)and dinorgestrel(DNG)of patients with ovarian endometriosis cyst(OEC)after their laparoscopic conservative treatment.Methods:90 patients with OEC who had undergone laparoscopic exfoli-ation of OEC in the hospital were selected and were divided into two groups(90 cases in each group)according to the random number table method from April 2021 to April 2022.After surgery,the patients in the control group were treated with GnRHa and the patients in the observation group were treated with DNG.All the patients in the two groups were followed up for 12 months.The clinical data,the levels of tumor markers and ovarian function indexes,the postoperative recurrence and the adverse reactions rate of the patients were analyzed and compared between the two groups.The regression analysis was performed to analyze the recurrence factors of OEC of the patients.Results:In the 12th month of follow up,the levels of the ovarian function indexes,such as serum ollicle stimulating hormone,lutein-izing hormone,estradiol and antit Mullerian hormone of the patients in the two groups had decreased significantly,and the decrease degree of which of the patients in the observation group were significantly greater than those of the pa-tients in the control group.The estradiol level of the patients in the control group had decreased to less than 20pg/ml in the first month after surgery,and the patients were given maintenance treatment by reversely adding half or one tablet tibolone.The level of estradiol of the patients in the control group had decreased earlier than that of the patients in the.observation group.In the 6th month or the 12th month after surgery,the quality of life score of the patients in both group had increased significantly,and which(87.35±4.47 points or 92.14±4.51 points)of the patients in the observa-tion group was significantly higher than that(72.46±4.22 points or 78.26±4.48 points)of the patients in the control group.The pain VAS score of the patients in both groups had decreased significantly,and which(0.58±0.81 points or 1.49±1.25 points)of the patients in the observation group in the 6th month or the 12th month after operation was sig-nificantly lower than that(1.74±points or 2.91±1.62 points)of the patients in the control group(all P<0.05).The recurrence rate(4.4%)and the pregnancy rate(36.4%)of the patients in the control group in 12 postoperative months had no significantly different from those(11.1%and 57.7%)of the patients in the observation group(P>0.05).The incidence of the adverse reactions(75.6%)of the patients in the control group was significantly higher than that(31.1%)of the patients in the observation group(P<0.05).Conclusion:GnRHa or DNG adjuvant therapy of the pa-tients after laparoscopic exfoliation of OEC can effectively reduce their postoperative recurrence of OEC,pain degree and adverse reactions rate.In comparison with that of GnRHa used,the application of DNG is more suitable for the pa-tients who need the postoperative long term management after laparoscopic exfoliation of OEC.