子宫内膜异位症腹腔镜手术后不同药物巩固治疗的疗效比较

Comparison of clinical effect of different drug in the treatment of endometriosis after laparoscopy.

目的:比较中重度子宫内膜异位症腹腔镜手术治疗后加用不同药物巩固治疗的效果。方法:45例患者术后不用药(A组);58例加用达那唑治疗(口服达那唑400mg,每日1次,疗程为6个月,B组);47例加用孕三烯酮治疗(口服孕三烯酮2.5mg,每周2次,疗程为6个月,C组);39例用促性腺激素释放激素激动剂(GnRH-a)治疗(皮下注射戈舍瑞林3.6mg,每月1次,疗程为6个月,D组)。比较4组患者术后复发、妊娠及用药副作用等情况。结果:术后2年A组复发率最高,显著高于其他3组(P<0.01);D组复发率最低,显著低于另3组(P<0.01),差异皆有统计学差异。B组和C组的复发率差异没有显著性(P>0.05)。4组不孕患者术后妊娠情况类似。结论:中重度子宫内膜异位症腹腔镜手术治疗后有必要加用药物巩固治疗,GnRH-a巩固治疗的疗效优于达那唑和孕三烯酮。术后药物治疗未能提高妊娠率。

Objective： To compare the effect of different drug in the treatment of mid-or severe endometriosis after laparoscopy. Methods：The postoperative women with mid -or severe endometriosis were divided into four groups,45 without endocrinal therapy（ Group A） ,58 treated with danazol （danazol 400mg po qd, Group B ） ,47 treated with gestrinone （gestrinone 2. 5rag qiw, Group C） ,39 treated with ganodotropin releasing hormone-analogue（ GnRH-a ）（ GnRH-a 3.6mg iH qm, Group D）. The recurrence,following pregnancy rate and side effects were compared. Results ：Two years.after laparoscopy,the recurrent rates of Group A was the highest （P 〈0.01 ）,the recurrent rates of Group D was the lowest ,no significant difference was observed in recurrence rate between Group B and C. There were no significant difference in pregnancy rates among the four groups. Conclusion： It is necessary for patients with mid - or severe endometriosis after laparoscopy to add endocrinal therapy. The effect of GnRH-a is prior to danazol and gestrinone. The pregnancy rate can not be improved with endocrinal therapy after laparoscopy.