米非司酮与孕三烯酮对子宫内膜异位症术后辅助治疗的疗效观察

Clinical study of effect of mifepristone and gestrinone as a subsidiary treatment after endometriosis surgery

目的探讨米非司酮及孕三烯酮用于子宫内膜异位症术后辅助治疗的疗效及安全性。方法选择开腹或腹腔镜手术确诊为子宫内膜异位症并行保守性手术治疗的患者151例,随机分为米非司酮组、孕三烯酮组及未用药组。米非司酮组49例患者和孕三烯酮组60例患者,均于术后第1周开始服药,连服6个月;未用药组术后未用任何药物。术后随访3～18个月,观察比较治疗前后两组患者疼痛症状和体征的控制率、临床有效率、复发率、性激素水平、月经变化、体质量改变、肝功能变化。结果随访率97.4%(151/155),米非司酮组及孕三烯酮组患者有效率、症状控制率分别为78.7%、93.1%及83.0%、96.6%,未用药组为34.8%、58.7%,差异有统计学意义(X^2=44.31,P<0.01;米非司酮组及孕三烯酮组患者累计复发率分别为14.9%及3.4%,未用药组为32.3%,X^2=16.26,P<0.01,而米非司酮组与孕三烯酮组比较,差异有统计学意义(X^2=4.34,P<0.05)。米非司酮组用药前雌二醇水平为(209±78)pmol/L,用药6个月时雌二醇水平下降至(92±2)pmol/L.用药前后比较差异有统计学意义(u=9.64,P<0.01);孕三烯酮组用药前雌二醇水平为(211±62)pmol/L.用药6个月时雌二醇水平为(75±35)pmol/L,但仍维持在卵泡早期水平,用药前后比较,差异有统计学意义(u=14.55,P<0.01);比较两组患者用药6个月时雌二醇水平,差异有统计学意义(u= 2.72,P<0.01);停药6个月时,两组患者雌二醇水平均能恢复至用药前水平。结论子宫内膜异位症患者术后辅以孕三烯酮的治疗效果、控制及降低复发方面优于米非司酮,可以作为子宫内膜异位症手术后辅助治疗最好的联合疗法之一。

Objective To evaluate the efficiency and safety of mifepristone and gestrinone in subsidiary treat-ment after endometriosis surgery. Methods Totally 151 patients diagnosed as endometriosis with conservative surgery treatment or laparoscopic operation were divided into three groups;49 cases in the group of mifepristone received mifepristone tablets 10mg every day for 6 months from the first week of postoperation,60 cases in the group of gestrinone received gestrinone capsules 2.5mg twice every week for 6 months. Cases in the group of control did not receive any postoperative medical treatment. The duration of follow-up after surgery was censored at 3-18 months. Patients＇ controlling rate of ache symptoms and signs, clinical efficiency, recurrence rate, sex hormone level, menstrual and weight changes, liver and renal functions were recorded and compared. Results The follow up rate is 97.4 %, the efficacious rate and symptoms controlling rate of mifepristone group and gestrinone group were 78.7 %, 93.1% respectively, which of the control group were 34.8 %, 58.7 % respectively. There were significant differ- ences, X^2 = 44.31, P 〈 0.01 ; the recurrence rate of mifepristone group and gestrinone group were 14.9 % and 3.4 % respectively,the control group was 32.3%, X^2 = 16.26, P 〈 0.01. There were significant differences between mifepristone group and gestrinone group,x^2 = 4.34, P 〈 0.05 ; serum estradiol（E2） level of mifepristone group was significantly reduced from （209±78）pmol/L to （92±2）pmol/L,compared with before and after 6 months＇ medical treatment. There were significant differences, u = 9.64, P 〈 0.01. Serum estradiol （E2） level of gestrinone group was significantly reduced from （211±62）pmol/L to （75 ±35）pmol/L,compared with before and after 6 months＇ medical treatment, but serum E2 was maintained at the level of early follicular phase,there were significant differences, u =2.72,PK 0. 01; stopping medical treatment for 6 months, both of the serum E2 increased to the previous level. Conclusion The value gestrinone has on treatment effect and reducing recurrence rate is better than mifepristone does on endometriosis postoperative treatment, which could be considered one of the best associated treatment of endometriosis postoperative subsidiary treatment.