子宫内膜异位症合并内膜增生不孕患者术后应用地屈孕酮临床观察

Clinical Study on the Application of Tedrosterone on Endometriosis with Infecund Endometrial Hyperplasia after Surgery

目的:观察子宫内膜异位症合并内膜增生的不孕患者术后应用地屈孕酮治疗后临床妊娠结局与内膜病变复发率,为治疗此类的不孕患者提出新方法。方法:90例子宫内膜异位症(单侧或双侧卵巢巧克力囊肿)合并不孕患者,因子宫内膜病变施行宫腔镜手术,术后随机分为1组与2组,每组各45例(5例失访)。1组术后使用地屈孕酮后半周期治疗2组术后使用地屈孕酮全周期治疗。对比两组患者治疗后内膜病变复发率和妊娠率。结果:1组和2组的年累积妊娠率分别为36.4%和34.1%差异无统计学意义(P>0.05);内膜病变复发率分别为13.6%和7.3%,差异有统计学意义(P<0.001)。无严重药品不良反应发生。结论:子宫内膜异位症合并内膜良性增生病变患者术后使用地屈孕酮治疗可取得较好的临床妊娠率;全周期地屈孕酮治疗的内膜病变复发率较后半周期治疗组更低,更适合子宫内膜异位症合并内膜增生的不孕患者。

Objective:To explore clinical pregnancy outcome and recurrence rate of endometrial lesions after treatment with dydrogesterone in infertility patients with endometriosis and endometrial hyperplasia after surgery to provide new methods for clinical treatment of such infertility patients.Methods:Totally 90 patients with endometriosis(unilateral or bilateral ovarian sac)with infertility underwent hysteroscopic surgery for endometrial lesions,and postoperative pathology confirmed benign lesions and endometrial inflammation was excluded.The patients were randomly divided into group 1 and group 2 after surgery with 45 cases in each group.All the patients were followed up for one year(5 cases were lost during the follow-ups).Group 1 received post-half-cycle treatment with dydrogesterone,and group 2 received full-stage treatment with dydrogesterone.After the treatment,the recurrence rate of endometrial lesions and pregnancy rate were compared between the groups.Results:The cumulative pregnancy rate of group 1 was 36.4%,and that was34.1%in group 2.There was no significant difference between the groups(P>0.05).The recurrence rate of endometrial lesions in group 1 was 13.6%,and that was 7.3%in group 2.The difference between the groups was statistically significant(P<0.001).No serious adverse drug reactions were reported in the study.Conclusion:Patients with endometriosis(nica)and endometrial benign prostatic hyperplasia can both achieve good clinical pregnancy rate after full-stage and the post-half-cycle treatment with dydrogesterone after surgery.The recurrence rate of endometrial lesions is lower in full-stage treatment group when compared with that of post-half-cycle treatment group,which is more suitable for infertility patients with endometriosis and intimal hyperplasia.