腹腔镜手术联合促性腺激素释放激素激动剂治疗中、重度内异症的疗效研究

Study on the Efficacy of Laparoscopic Combined with Gonadotropin Releasing Hormone Agonist for the Treat-ment of Moderate or Severe Endometriosis

【目的】探讨腹腔镜手术联合促性腺激素释放激素激动剂（GnRH-a）治疗中、重度子宫内膜异位症（内异症）的临床疗效。【方法】回顾性分析湖南省人民医院2010年3月至2013年3月收治的50例内异症患者临床资料。根据手术前后联合使用GnRH-a情况分为A和B两组。术前术后联合治疗组（A组）：15例，腹腔镜手术前皮下注射GnRH-a共2～3次，术后再注射3次；术后联合治疗组（B组）：35例，腹腔镜手术后皮下注射GnRH-a共3-6次。术后所有患者随访12个月。比较两组患者的手术时间、术中出血量、术后恢复情况、疼痛症状视觉模拟评分（VAS）、复发率及药物不良反应等指标。【结果】A组与B组手术时间分别为（65±12）min、（92±16）min；术中出血量分别为（105±12）mL、（190±29）mL ；A组患者术后下床活动时间及肛门排气时间均早于B组；治疗后随访至术后12个月，A组和B组VAS分别由术前3．7（1．7～6．5）分、3．2（1．4～6．4）分下降至1．6（1．0～3．6）分、1．6（1．1～3．5）分，A组和B组患者随访期间复发率分别为7％（1/15）、6％（2/35），两治疗组之间比较无统计学意义。【结论】腹腔镜手术联合术前术后使用GnRH-a治疗中、重度内异症能够缩短手术时间、减少术中失血、促进术后恢复；但是，与术后联合使用GnRH-a在改善术后痛经、降低复发率方面效果相当。

[Objective]To explore clinical efficacy of laparoscopy combined with gonadotropin-releasing hormone agonists （GnRH-a） for the treatment of moderate or severe endometriosis .[Methods]Clinical data of 50 patients with endometriosis in Hunan provincial people＆#39;s hospital from Mar .2010 to March 2013 were analyzed retrospectively .According to the treatment methods ,all patients were divided into group A and group B .Preoperative combined with postoperative treatment group （group A ,n=15） was given subcutaneous injection with GnRH-a for 2～3 times before laparoscopy and re-injection for 3 times after laparoscopy .Postoperative treatment group（group B ,n =35） was given subcutaneous injection with GnRH-a for 3～6 times after laparoscopy .All patients were followed up for 12 months after operation .Operation time ,intraoperative blood loss ,postoperative recovery ,pain symptom visual analog scale （VAS ） ,recurrence and adverse reaction were compared between two groups .[Results] The operation time in group A and group B were （65 ± 12）min and （92 ± 16）min ,respectively .The amount of bleeding in group A and group B were （105 ± 12）mL and （190 ± 29）ml ,respectively .The time of out-of-bed activity and anus exhaust time in group A after operation were earlier than those in group B .The VAS scores in group A and group B at 12-month follow up after operation were decreased from preoperative 3 .7（1 .7～6 .5） and 3 .2（1 .4～6 .4） points to 1 .6（1 .0～3 .6） and 1 .6（1 .1～3 .5） points ,respectively .The recurrence rates in group A and group during follow up were 7% （1/15） and 6%（2/35） ,respectively .There was no significant difference between two groups .[Conclusion] Laparoscopy combined with preoperative and postoperative GnRH-a therapy for the treatment of moderate or severe endometriosis can shorten the operation time ,decrease intraoperative blood loss and promote postoperative recovery .However ,laparoscopy combined with preoperative and postoperative GnRH-a therapy has the same efficacy in improving postoperative pain and reducing the recurrence rate as the postoperative GnRH-a therapy .