GnRH-a联合LNG-IUS治疗子宫内膜异位症腹腔镜术后效果分析

Effect of levonorgestrel-releasing intrauterine system combined with GnRH analogue treatment on endometriosis after laparoscopic operation

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.