子宫内膜异位症腹腔镜术后药物治疗临床效果分析

Analyses of the Clinical Effects for Endometriosis with Laparoscopic Operation and Chemical Therapy

目的通过对子宫内膜异位症（Endometriosis，EMs）腹腔镜术后行GnRH．0／．和反向添加治疗（AddBackTherapy，ABT），观察患者更年期指数（KuppermanMenopausalIndex，KMI）、疼痛视觉模拟评分（VisualAnalogueScore，VAS）、以及血清CA。阳性率与停药后复发率。方法选取2009年10月～2010年12月在苏州大学附属第一医院患卵巢巧克力囊肿行腹腔镜手术者的育龄妇女为研究对象，按美国生育学会（AFS）分期标准，选取Ⅲ期和Ⅳ期共45例。其中使用GnRH—Ot治疗3个月15例（A组），6个月15例（B组），6个月ABT15例（C组）。结果总体上看，经期疼痛VAS在分组之间没有统计学意义（F=0．20，P=0．8188），而在手术前后有统计学意义。术前、术后第1天及术后3个月时点，KMI在3组之间没有统计学差异，而随访6个月时点，KMI在B组和C组之间有统计学意义（F=77．13，P〈0．01）。重复测量分析结果显示（仅对B组和C组），时间效应有统计学意义（F=387．16，P〈O．01）。B组KMI随着时阃而逐渐升高，C组亦表现出随时间变化而升高趋势。血清CA。阳性率术后明显低于术前（2＂2=38．05，P〈0．01）；CA。阳性率在3组之间的分布则没有统计学意义（X2=1．5144，P=O．4690）。虽然A组复发率偏高（40％），但是复发率在3组之间的分布没有达到统计学显著水平（X2=0．8295，P=0．6605）。结论腹腔镜术后联合GnRH．仪及ABT是治疗EMs患者的有效手段。

Objective To evaluate the effects of endometriosis with laparoscopic operation after GnRH-α and Add Back Therapy（ABT） in Kupperman Menopausal Index（KMI）,Visual Analogue Score（VAS）,positive rate of CA125,and the recurrence rate.Methods Forty-five women with endometriosis were diagnosed by surgery（AFS Ⅲ IV） in the First Affiliated Hospital of Soochow University between October 2009 to December 2010. The participants were assigned into three groups randomly（15 patients each）,only using GnRH-et for three months（Group-A）,for six months（Group-B） and GnRH- o~ with ABT（Group-C）.Results VAS had no statistical significance in three groups（F=0.20,P=0.8188）,but showed statistical significance between pre-operation and post-operation.As for KMI,in the time of pre-operation,post-operation of the first day and 3 month,there had no statistical significance.ABT group had lower KMI comparing with non-ABT group for 6 month.Repeated analysis suggesting time effects were influenced KMI level（F=387.16,P 〈 0.01）,KMI level increased with the time for non- ABT group,and ABT group showed the same tendency.The positive of serum CA125 in post-operation was lower as compared with pre-operation（z2=3 8.05,P 〈 0.01）,and the positive frequency of serum CA125 among three groupswere of no statistical significance（z2=l.5144,P=0.4690）.As for recurrence,there were no statistical significance among three groups,although the third month therapy group was mild higher（40%）.Conclusion GnRH- combined with ABT therapy after laparoscopic was the effective measures.