中重度卵巢型子宫内膜异位囊肿腹腔镜保守性手术后辅助促性腺激素释放激素类似物治疗的临床疗效分析

Clinical value of laparoscopic conservative operations combined with gonadotropin-releasing hormone analogue on treatment of moderate and severe ovarian endometriosis

目的探讨中重度卵巢型子宫内膜异位囊肿腹腔镜保守胜手术后辅助促性腺激素释放激素类似物（GnRH—a）治疗的临床疗效。方法收集行腹腔镜保守性手术治疗的中重度卵巢型子宫内膜异位囊肿患者265例，有生育要求47例。按术后是否辅助用药和用药种类将患者进行分组：GnRH．a组95例，其中用药3个月64例，用药6个月31例；孕三烯酮组68例，其中用药3个月38例，用药6个月30例；未用药组102例。所有患者随访2年，观察疗效、复发、有生育要求患者的妊娠情况、药物不良反应。结果GnRH—a组用药6个月和孕三烯酮组用药6个月患者缓解率明显高于未用药组患者[83．9％（26／31）和73．3％（22／30）比52．9％（54／102）]，GnRH—a组用药6个月患者缓解率明显高于GnRH—a组用药3个月患者[64．1％（41／64）]，差异有统计学意义（P〈0．05）。GnlIH—a组用药3个月、GnRH—a组用药6个月、孕三烯酮组用药6个月患者复发率明显低于未用药组患者[12．5％（8／64），9．7％（3／31），10．0％（3／30）比27．5％（28／102）]，差异均有统计学意义（P〈0．05）；孕三烯酮组用药6个月患者复发率明显低于孕三烯酮组用药3个月患者，差异有统计学意义（P〈0．05）。GnRH—a组用药3个月、GnRH．a组用药6个月、孕三烯酮组用药6个月患者复发时间明显长于未用药组患者[（14．05±1．97），（16．76±1．53），（16．12±2．15）个月比（12．85±1．80）个月]，差异均有统计学意义（P〈O．05）；孕三烯酮组用药3个月患者复发时间与未用药组患者比较差异无统计学意义（JP〉0．05）。GnRH。a组和孕三烯酮组有生育要求患者妊娠比例高于未用药组，但差异均无统计学意义（P〉0．05）。GnRH—a组绝经期症状发生率明显高于孕三烯酮组[50．5％（48／95）比16．2％（11／68）]，经反向添加治疗后均缓解；GnRH—a组阴道不规则出血、痤疮和转氨酶升高发生率明显低于孕三烯酮组[1．1％（1／95）比7．4％（5／68），0比8．8％（6／68），0比5．9％（4／68）]，差异均有统计学意义（P〈0．05）。结论卵巢型子宫内膜异位囊肿腹腔镜保守性手术后辅助GnRH—a和孕三烯酮6个月能够显著提高缓解率、降低复发率，术后辅助GnRH—a、孕三烯酮的妊娠率高于未用药患者，GnRH-a不良反应低于孕三烯酮。

Objective To explore the clinical value of gonadotropin-releasing hormone analogue （GnRH-a） by analyzing the efficiency of GnRH-a treatment for moderate and severe endometriosis after laparoscopic conservative operations. Methods Two hundred and sixty-five females who accepted laparoscopic conservative operation were enrolled in this study, and they were confirmed by pathology for ovarian endometriosis cyst, in phase 11 and IV, 47 patients had fertility desire. According to whether use the drug and auxiliary species the postoperative cases were divided into 5 groups： 102 cases without endocrinal therapy（untreated group ）, GnRH-a group of 3 months in 64 cases, GnRH-a group of 6 months in 31 cases; gestrinone group of 3 months in 38 cases, and gestrinone group of 6 months in 30 cases. All patients were followed up for 2 years, observed drug clinical effects, remission rate, improvement rate, recurrence rate, pregnancy outcomes and side effects. Results The remission rate in GnRH-a group of 6 months and gestrinone group of 6 months was significantly higher than that in untreated group [ 83.9% （26/31 ）, 73.3% （22/30） vs. 52.9%（54/102） ], the remission rate in GnRH-a group of 6 months was significantly higher than that GnRH-a group of 3 months [ 64.1% （41/64） ], there was significant difference（P 〈 0.05 ）. The recurrence rate in GnRH-a group of 3 months , GnRH-a group of 6 months , gestrinone group of 6 months was significantly lower than that in untreated group [ 12.5% （8/64）, 9.7% （3/31 ）, 10.0% （3/30） vs. 27.5% （28/102） ] （P 〈 0.05 ）. The recurrence rate in gestrinone group of 6 months was significantly lower than that in gestrinone group of 3 months （P 〈 0.05）. The recurrence time of GnRH-a group of 3 months, GnRH-a group of 6 months, gestrinone group of 6 months was significantly longer than that in untreated group [（14.05 ± 1.97）, （16.76 ± 1.53）, （16.12±2.15）months vs. （12.85± 1.80）months] （P 〈0.05）. The recurrence time of gestrinone group of 3 months and untreated group had no significant difference（P 〉 0.05 ）. The pregnancy rate of GnRH-a group and gestrinone group was higher than that in untreated group, but there was no significant difference （P〉 0.05）. The rate of menopausal symptom in GnRH-a group was higher than that in gestrinone group [ 50.5%（48/95 ） vs. 16.2%（ 11/68 ） ]. The rate of abnormal bleeding in vagina, acne and side-effect of aminotransferase in GnRH-a group were significantly lower than those in gestrinone group [ 1.1%（ 1/95 ） vs. 7.4%（5/68） ,0 vs. 8.8%（6/68）, 0 vs. 5.9%（4/68） 1 （P 〈 0.05 ）. Conclusions Laparoscopic conservative operations combined with GnRH-a on treatment of moderate and severe ovarian endometriosis can significantly improve remission rate, decrease recurrence rate. GnRH-a or gestrinone for 6 months, the pregnancy rate increases. In addition the side reactions of the two medicine have statistic difference, which of GnRH-a is lower.