GnRH-a减量疗法用于重度子宫内膜异位症术后的临床疗效

Effect of decrement therapy of gonadotropin-releasing hormone agonist on severe endometriosis after laparoscopic surgery

目的:探讨重度子宫内膜异位症保守手术后,运用促性腺激素释放类似物(GnRH-a)减量疗法的临床疗效。方法:重度子宫内膜异位症患者24例,经腹腔镜保守手术治疗后随机分为3个小组,组A为常规剂量治疗组;组B减量疗法治疗组;组C为反加疗法治疗组。比较各组间在疼痛缓解程度、复发率、低雌激素表现、雌激素水平等方面是否有统计学差异。结果:腹腔镜手术联合GnRH-a减量疗法能有效缓解疼痛,防止复发,B组与其他两组相比,无明显差异;并能有效减少低雌激素表现;GnRH-a减量疗法治疗后,监测血E2的均值介于20～50pg/mL这一治疗的窗口域值内。结论:重度子宫内膜异位症患者,经腹腔镜保守手术治疗后,运用GnRH-a减量疗法在预防复发的同时,能有效防止低雌激素的表现。

Objective To investigate the effect of decrement therapy of gonadotropin-releasing hormone agonist （GnRH-a） on severe endometriosis after laparoscopic surgery. Methods Twenty-four patients with severe endometriosis after laparoscopic surgery were randomly divided into 3 groups, group A received 3.75 mg of triptorelin intramuscular injection, every 28 days, for 6 times; group B received 1.88 mg of triptorelin intramuscular injection, every 28 days, for 6 times; group C received 3.75 mg of triptorelin intramuscular injection, every 28 days, for 6 times, plus 0.3 mg of premarin and 2 mg of medroxyprogesterone acetate, every day after the second times. The pain relief, recurrence rate, and severity of vasomotor symptoms in each group were observed. Results The decrement therapy of GnRH-a plus laparoscopic surgery could effectively relieve pain and prevent recurrence of endometriosis, could effectively reduce vasomotor symptoms, and could maintain favorable levels of plasma E2 （20-50 pg/mL）. Conclusion The decrement therapy of GnRH-a after laparoscopic surgery in severe endometriosis patients can effectively prevent recurrence, and effectively prevent the vasomotor symptoms.