腹腔镜手术治疗中重度内膜异位症的术后用药

Effects of endocrinal therapy on the treatment of endometriosis after laparoscopy

目的 探讨中重度内膜异位症腹腔镜手术治疗后 ,加用内分泌治疗的必要性以及副作用。方法 1 9位患者术后不用药 (A组 )、 1 9例加用人工合成孕激素治疗 (B组 ) ,1 8例促性腺激素释放激素激动剂(GnRH -a)治疗 (C组 ) ,比较三组患者术后复发、妊娠结局及用药副作用情况。结果 A组 1 5 8%复发 ,B组2 6 3%复发 ,C组 1 7 0 %复发 ,三组差异无显著性 (P >0 0 5 )。三组不孕患者妊娠情况差异无显著性 (P >0 0 5 )。B组 7例患者未完全闭经 ,C组全部闭经 ,B组及C组闭经时间分别为 (4 4 0± 2 3 7)d及 (4 0 0± 1 3 6 )d ,复潮时间分别为 (4 8 7± 2 6 6 )d及 (5 8 1± 1 7 4 )d ,两组间差异无显著性 (P >0 0 5 ) ,但B组患者闭经及复潮的发生更加不确定。B组患者以高雄激素症状为主 ,5例患者服药后声音变低钝 ,C组患者以低雌激素所至围绝经期征候为主 ,均于停药后恢复。结论 对于有生育要求的患者 ,手术者若能彻底地清除盆腔内膜异位病灶 ,术后可不用药。 6～ 1 2个月后未妊娠者 ,考虑用药及助孕治疗。孕激素类药物使用前应充分交代该药的副作用 。

Objective To study necessity and side effects of endocrinal therapy in patients with mid- or severe endometriosis after laparoscopy. Methods The postoperative women with mid- or severe endometriosis were divided into three groups, 19 without endocrinal therapy (Group A), 19 treated with synthesis progesterone (Group B) and 18 with ganodotropin releasing hormone-analogue (Group C). The recurrence, following pregnancy rate and side effects were compared. Results In Group A, B and C, the recurrent rates were 15 8%, 26 3% and 17 0%, respectively. There was no significant difference in recurrence rates or pregnency rates among the three groups. No significant difference was observed in menstrual recovery between Group B and C. The most severe side-effects of Group B was hyper-androgen syndrome, and menopause syndrome in Group C. Conclusions For women with endometriosis and infertility, who are willing to bear babies, endocrinal therapy can be suspended if completely cystectomy can be insured. Endocrinal therapy and fertility assistant therapy can be applied if persistent infertility after 6-12 months. The side effects must be noticed, especially in women of specifical profession.