摘要
目的:探讨中、重度子宫内膜异位症腹腔镜手术后应用促性腺激素释放激素激动剂(GnRHa)、左炔诺孕酮宫内缓释系统(LNG-IUS)、GnRH-a+LNG-IUS后续治疗的效果。方法:回顾性分析腹腔镜保守性手术切除证实盆腔子宫内膜异位症的117例患者的临床资料,根据患者选择情况分组:术后单纯应用GnRH-a组30例(A组),术后应用左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)治疗组43例(B组),应用GnRH-a+LNG-IUS组44例(C组)。在手术前及手术后第3、6、12、24个月随访观察痛经评分、血清糖类抗原CA125水平、月经改变、手术后复发率等多项指标。结果:三组手术后随访2年,痛经评分及血清CA125水平均较术前明显降低,A组与C组术后均应用GnRH-a,在随访的3个月、6个月时痛经评分与B组比较有统计学意义(P<0.05)。随访2年内,三组内异囊肿复发率分别为33.33%,9.30%,9.09%,B组与C组月经改变比较,B组在放置曼月乐半年内不规则出血、经期延长发生率高于C组,但放置曼月乐1年、2年后差异无统计学意义。结论:内异症保守性手术后预防复发,从长期用药考虑联合LNG-IUS和GnRH-a+LNG-IUS均有效地缓解疼痛症状,降低血清CA125水平,缩小卵巢内异症囊肿体积,是一种有效、安全、持续时间长、全身不良作用少、依从性高的治疗方法。
Objective: To evaluate the effects of levonorgestrel - releasing intrauterine system ( LNG - IUS ) combined with Gn- RH analogue (GnRHa) on treatment for inhibiting recurrence of endometriosis focus after severe endometriosis laparoscopic operation. Methods: The clinical data of 117 patients who accepted laparoscopic conservative operation diagnosed by pathology was retro- spectively analyzed. The patients were divided into GnRH -a (group A, 30 cases), LNG - IUS (group B, 43 cases), GnRH -a + LNG- IUS (group C, 44 cases) groups. Dysmenorrhea score, CA125, menstuoal conditions and recurrence situations after 3, 6 months, 1,2 years of surgery were retrospectively analyzed. Results: Dysmenorrhea score, CA125 were decreased after operation 2 years among three groups. There were significant differences in dysmenorrhea score between group A, C and group B after operation 3 and 6 months ( P 〈 O. 05 ). Fol- lowed up of 2 years, endometriosis cyst recurrence rate of three groups was 33.33% , 9. 30%, 9.09% respectively. Compared with group C, irregular bleeding, menstrual extension was higher in group B after LNG - IUS inserted within half a year, but for I and 2 years after opera- tion there was no statistically significant difference between group B and C. Conclusion: Endometriosis after laparoscopic conservative opera- tion ibr prevention of relapse after treatment, from long - term medication taking combined with LNG - IUS and GnRHa + LNG - IUS are ef- fective in relieving pain symptoms, decreasing the level of CA125, reduced ovarian endometriosis cyst volume, is an effective, safe, lasted for a long time, the whole body with fewer side effects, high compliance treatment method.
出处
《中国妇幼保健》
CAS
北大核心
2013年第24期3917-3919,共3页
Maternal and Child Health Care of China