腹腔镜术后药物治疗子宫内膜异位症周期及疗效的临床探讨

Clinical investigation on curative effect of medication for endometriosis after laparoscopic surgery

目的:探讨腹腔镜术后米非司酮、促性腺激素释放激素激动剂、促性腺激素释放激素激动剂(GnRH-α)联合反向添加治疗子宫内膜异位症不同用药周期的各临床效果。方法:选择85例子宫内膜异位症合并不孕患者分为GnRH-α治疗A组21例,米非司酮治疗B组22例,GnRH-α联合反向添加治疗C组20例;未用药对照D组22例。此85例患者均在腹腔镜下行保守手术治疗。GnRH-a组于术后3～5天皮下注射曲普瑞林3.75 mg,每隔4周注射1次;GnRH-a联合反向添加组同GnRH-a组之外于注射第1支曲普瑞林同时口服戊酸雌二醇1mg及安宫黄体酮6 mg至治疗结束;米非司酮组术后口服米非司酮10mg,每日1次;未用药组术后不用药。结果:①3个月内疼痛评分各用药组均比对照组评分低,差异具有统计学意义(P<0.05),绝经期症状GnRH-α联合反向添加组症状评分较其他用药组低(P<0.05),各用药组均有不同程度的肝功能损伤,以米非司酮组较轻(P<0.05);②各治疗组治疗后患者血清卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)、抗子宫内膜抗体(EmAb)、CA125水平较未用药组均明显降低(P<0.05);③GnRH-α联合反向添加治疗3月后停药,之后3月内受孕率最高,高于其他各组(P<0.05),且绝经期症状无明显加重,肝功能损伤明显减轻。结论:腹腔镜保守手术治疗后应用GnRH-α联合反向添加治疗,短期疗法(此研究以3月为准)可有效提高子宫内膜异位症患者受孕率及疼痛缓解率,降低术后复发率,且不良反应相对较小。

Objective： To explore the curative effects of add - back therapy with mifepristone, gonadotropin - releasing hormone （GnRH） combined with GnRH -α at different medication times for endometriosis after laparoscopic surgery. Methods ： Eighty - five infer- tile patients with endometriosis were divided into group A （including 21 patients treated with GnRH -α, group B （including 22 patients treated with mifepristone）, group C （ including 20 patients treated with GnRH-α combined with add - back therapy）, and group D （ inclu- ding 22 patients without medication） ; all the 85 patients underwent conservative laparoscopic surgery. The patients in group A were treated with subcutaneous injection of triptorelin （3.75 rag） at 3 - 5 days after surgery, once every four weeks; the patients in group B were treated with oral administration of mifepristone, once a day; and the patients in group D didnt receive medication; the patients in group C were trea- ted with subcutaneous injection of triptorelin （ 3.75 rag） at 3 - 5 days after surgery, once every four weeks and oral administration of estradiol valerate （1 rag） and medroxyprogesterone acetate （6 rag） until the end of treatment at the same time of the first injection of triptorelin. Results ： The scores of pain in group A, group B, and group C within three months were statistically significantly lower than that in group D （ P 〈 0.05 ） , the score of menopausal symptoms in group C was statistically significantly lower than those in the other three groups （ P 〈 0. 05 ） , different degrees of hepatic injury were found in group A, group B, and group C, hepatic injury in group B was milder （ P 〈 0. 05 ） . After treatment, the serum levels of follicle-stimulating hormone （FSH） , luteinizing hormone （LH）, estrogen, endometrial antibody （EMAb） , and CA125 in group A, group B, and group C were statistically significantly lower than those in group D （P 〈 0. 05 ） . The treatment in group C stopped after three months, and the fertilization rate during the subsequent three months was the highest, which was statistically sig- nificantly higher than those in the other three groups （P 〈 0. 05 ） , menopausal symptoms didnl aggravated significantly, and hepatic injury relieved obviously. Conclusion： Short - term （ three months adopted in this study） GnRH -α combined with add - back therapy after lapa- roscopic surgery can effectively improve fertilization rate and remission rate of pain in patients with endometriosis, reduce postoperative recur- rence rate, and the adverse reactions are mild.