卵巢子宫内膜异位囊肿保守性术后不同治疗措施的临床疗效观察

Clinical Effects of Different Medical Treatment for Endometrioma after Conservative Laparoscopic Surgery

目的:探讨卵巢子宫内膜异位囊肿(简称卵巢内异囊肿)术后不同治疗措施对复发率及复发时间的影响。方法:回顾分析152例首次行腹腔镜下卵巢囊肿剔除的卵巢内异囊肿患者的临床资料,并进行随访追踪其复发时间、复发率。结果:平均随访时间12个月,术后总复发率39.5%(60/152)。口服内美通治疗组、GnRH-a治疗组、口服安宫黄体酮治疗组、术后枸橼酸氯米芬促排卵治疗组、术后未用药组,复发率分别为:43.8%,36.8%,15.4%,56.7%,42.3%,两两比较。枸橼酸氯米芬促排卵治疗组,安宫黄体酮组与其他组比较差异有统计学意义(P<0.05)。五组平均复发时间(月)为12.4、13.7、13.3、8.1、12.3,术后应用枸橼酸氯米芬促排卵治疗组的复发时间与其它组比较差异有显著性(P均<0.05)。结论:卵巢内异位囊肿腹腔镜保守术后使用内美通与戈舍瑞林治疗虽在一定程度上可延长复发时间(但差异无统计学意义),但对复发率无明显影响。术后应用枸橼酸氯米芬促排卵治疗可提高复发率及缩短复发时间,为内异症保守性手术后复发的危险性相关因素,术后孕激素治疗6个月可降低复发率,为内异症保守性手术后复发的保护性相关因素。

Objective： To investigate the effects of medical treatment on the recurrence of endometrioma after conservatine laparoscopic surgery. Method： 152 patients with endometrioma underwent conservative laproscopic surgery were followed up,and the rate and time of recurrence was analyzed. Result： The total rate of recurrence was 39.5% after following-up for an average of 12months.The rate and time of recurrence in patients with endometrioma who had oral medroxprogesterone therapy,GnRH-a treatment,oral gestrinone therapy,postoperative administration of clomiphene and had no medical treatment after surgery were 43.8%,36.8%,15.4%,56.7%,42.3% respectively.There were significant differences of the rate of recurrence among the patients with oral gestrinone,clomiphene treatment and other medical treatment after surgery（P〈0.05）.There were significant differences of time of recurrence among the patients with clomiphene and other medical treatment after surgery（P〈0.05）. Conculsion ：Our results suggest that medical therapy with medroxprogesterone and GnRH-a has no influence on the recurrence rate and time in patients with endometrioma after conservative laparoscopic surgery,although the long interal of recurrence occurs in patients with the two medical treatments.Medical therapy with clomiphene will improve the recurrence rate and shorten the recurrence time.Postoperative administration of clomiphene is the risk factors for recurrence of endometriosis whereas post operative administration of medroxprogesterone for 6 months is the protective factors