卵巢子宫内膜异位囊肿腹腔镜保守性手术后治疗方法的应用评价

Application evaluation of treatment methods after laparoscopic conservative surgery with ovarian endometriosis cyst

目的探讨卵巢子宫内膜异位囊肿腹腔镜保守性手术后后续治疗方法的临床价值。方法卵巢子宫内膜异位囊肿Ⅲ～Ⅳ期并经腹腔镜手术治疗的患者64例,按术后自愿接受LNG-IUS、孕三烯酮或GnRH-a治疗分为3组：A组（LNG-IUS组）21例,B组（孕三烯酮组）23例,C组（GnRH-a组）20例。观察3组治疗前、后3个月、6个月、1年、2年的痛经程度[即视觉模拟评分（VAS）]、月经量、血清CA125的变化及3组复发率的比较。结果 3组患者治疗后痛经VAS评分、月经量、血清CA125水平明显下降,与手术前比较,差异均有统计学意义（P〈0.05）。3组治疗后3、6个月时痛经VAS分值下降、月经减少、血清CA125下降效果相当;治疗后2年,B组、C组患者上述指标恢复到治疗前水平,而A组与治疗6个月时水平相当,与B组、C组比较差异有统计学意义（P〈0.05）,B组、C组间比较差异无统计学意义（P＆gt;0.05）。治疗1年后3组分别出现个别复发病例,治疗2年后A组复发率9.52%,B组复发率21.74%C组复发率15%,但3组间比较差异无统计学意义（P＆gt;0.05）。结论对于无生育要求的EMT患者,LNG-IUS与孕三烯酮、GnRHa的治疗效果相当,同时有避孕作用,且其价格比GnRHa制剂便宜,特别适用于合并子宫腺肌病的EMT患者长期的维持治疗,用药便捷有效,作为术后巩固治疗更为经济便利。

Objective To investigate the clinical value of several subsequent treatments after conservative surgery with ovarian endometriosis cyst. Methods Sixty-four patients diagnosed with ovarian endometriosis cyst of stage III to IV and performed with laparoscopic conservative surgery were divided into 3 groups according to their acceptance of treatment with LNG-IUS, gestrinone, or GnRH-a. There were 21 cases in Group A （LNG-IUS group ）, 23 cases in Group B （gestrinone group ）, and 20 cases in Group C （ GnRH-a group）. Before treatment, 3 months, 6 months, 1 year, and 2 years after the treatment, the degree of dysmenorrhea, i.e. visual analog scales （ VAS）, changes of menstrual capacity, and serum CA125 of 3 groups were observed, and the recurrence rate of all groups were compared. Results The VAS scores of dysmenorrhea, menstrual capacity, and serum CA125 level of patients in the 3 groups decreased obviously after the treatment, which were of statistical differences compared with those before the treatment （ P 〈 0.05 ）. After 3 and 6 months＇ treatment, the VAS scores of dysmenorrhea of patients in the 3 groups decreased, their menstrual capacity reduced and serum CA125 level dropped at the same degree. But 2 years after the treatment, the above-mentioned indicators of patients in Group B and C returned to the levels before the treatment, while the level of the indicators of Group A remained almost the same as that at 6 months, which were of statistical difference compared with those of Group B and C （P 〈 O. 05 ） ; but there was no statistical difference of the indicators between Group B and C （P 〉 O. 05）. As for the recurrence, a few cases occurred respectively in 3 groups 1 year after treatment; and 2 years after the treatment, the recurrence rate of Group A, B, and C was 9.52%, 21.74%, and 15% ,respectively, but there was no statistical difference between the 3 groups （P 〉 0.05 ）. Conclusion For EMT patients without bearing requirement, LNG-IUS has almost the same treatment effect as gestrinone and GnRH-a. Meanwhile, LNG-IUS has contraceptive effect, and costs less than GnRH-a, so it is especially applicable for the long-term treatment of the EMT patients combined with uterine adenomyosis for its convenience, effectiveness in drug use, and economy in the postoperative consolidation therapy.