Ⅰ～Ⅱ期子宫内膜异位症不孕术后使用促性腺激素释放激素激动剂的随机对照研究

Effect of administration of GnRH agonist on pregnancy occurrence after the laparoscope surgery of endometriosis

目的探讨短期使用促性腺激素释放激素激动剂（GnRH—a）在Ⅰ～Ⅱ期子宫内膜异位症（EMs）不孕患者腹腔镜术后的作用。方法采用单中心、前瞻性随机对照研究方法，把手术治疗后Ⅰ～Ⅱ期EMs不孕的病例，分成期待组40例、GnRH—a组40例，观察治疗后半年的妊娠情况。结果按要求完成治疗77例EMs不孕患者，腹腔镜术后和用药后半年妊娠26例，总累积妊娠率33．8％。期待组39例，妊娠13例，期待组有效观察166周期，周期妊娠率7．8％（13／166）。术后间隔平均（4．15±1．34）月妊娠。GnRH-a组38例，妊娠13例，GnRH—a组有效观察149周期，周期妊娠率8．7％（13／149）。用药后间隔平均（2．61±1．56）月妊娠。两组周期妊娠率比较，差异无统计学意义。妊娠间隔时间比较差异有统计学意义（P〈0．05）。结论对于Ⅰ～Ⅱ期EMs不孕患者，在腹腔镜保守治疗术后积极给予GnRH—a治疗3个月使自然妊娠间隔时间缩短，对于术后进行周期治疗可能有益，但不能提高累积妊娠率。

Objective： To evaluate the effect of using GnRH agonist（GnRH-a）after the laparoscopy（LP）surgery for treatment of endometriosis. Methods： Eighty infertile patients with stage I-]] endometriosis who underwent laparoscopy surgery were randomly divided into GnRH-a group （40 patients）and non-treatment group （40 patients）. Seventy seven patients completed the trial. The pregnancy rate within 6 months after treatment was observed. Results： Twenty-six of the 77 infertile patients with endometriosis were pregnant within 6 months after the treatment and the total pregnancy rate was 33.8 ;. In non-treatment group, 13 patients were pregnant in 166 cycles observed. The cycle pregnancy rate was 7. 8; （13/166）and the average pregnancy interval time after surgery was（ 4. 15 ± 1.34）months. In GnRH-a group, 13 patients were pregnant in 149 cycles observed. The cycle pregnancy rate was 81 7% （13/149） and the average pregnancy interval time was（ 2.61 ± 1.56 ） months. Although there was no significant difference in cycle pregnancy rate, the average pregnancy interval time after LP surgery was significantly different （P 〈 0. 05）between the two groups. Conclusions： For infertile patients with stage I- II endometriosis,the pregnancy interval time can be shorten by giving GnRH-a treatment for 3 months after the LP surgery,but the cumulative pregnancy rate is not significantly increased.