腹腔镜手术联合促性腺激素释放激素激动剂治疗中重度子宫内膜异位症的临床研究

Clinical research of laparoscope surgery combined with GnRH-a in the treatment of moderate or severe endometriosis

目的探讨腹腔镜微创手术联合促性腺激素释放激素激动剂(gonadotropin releasing hormone antagonist,GnRH-a)治疗中重度子宫内膜异位症(endometriosis,EMT)的临床疗效和安全性。方法分析2012年新泰市人民医院妇产科收治的82例中重度EMT患者临床资料,根据手术治疗前加用药物的不同分为GnRH-a组(28例)、口服避孕药组(28例)和单纯手术组(26例),比较3组患者术中、术后评价指标,疼痛症状视觉模拟评分(visual analogue scale,VAS),术后复发率和不良反应发生情况。结果 GnRH-a组较口服避孕药组和单纯手术组手术时间短、术中出血少、肛门排气和下床活动时间早(均P<0.05);随访12个月时,GnRH-a组VAS评分降低幅度明显高于其他两组,GnRH-a组复发率明显低于其他两组(均P<0.05)。GnRH-a组低雌激素血症发生7例,患者均可以耐受,停止药物治疗后症状均消失;4个月内所有患者月经均恢复正常。结论腹腔镜微创手术联合GnRH-a术前治疗中重度EMT可有效提高手术效果、术后恢复快、复发率低,短期用药安全。

Objective To investigate the efficacy and safety of laparoscope surgery combined with gonadotropin - releasing hormone agonist （GnRH -a） in the treatment of moderate or severe endometriosis. Methods Data of 82 patients with moderate to severe endometriosis in Xintai City People＇s Hospital from Jan to Dec. 2012 were collected, all cases were divided into GnRH -a group （28 cases）, oral contraceptive group （28 cases） and surgery group （26 cases） according to medication treatment before surgery. The indicators of preoperative and postoperative evaluation, pain visual analogue scale （VAS） , recurrence rate and adverse reaction were compared among the three groups. Results The operative time, the amount of blood loss in GnRH - a group were lower than in those in the other two groups. The activity time and anal exhaust time in GnRH - a group were earlier than those in the other two groups （P 〈 O. 05 ）. After 12 months followed - up, the reduction of VAS in GnRH - a group was significantly higher than those in the other two groups . The recurrence rate in GnRH - a group was significantly lower than that in the other two groups （ P 〈 0. 05 ）. 7 patients with low estrogen hyperlipidemia occurred in GnRH - a group, the adverse effects could be tolerated. The symptoms were disappeared when medication treatment stopped. Normal menstruation retrieved for all patients after 4 months. Conclusion The laparoscopic surgery combined with preoperative GnRH - a in treatment of moderate to severe endometriosis can effectively improve surgical effects, which has advantages of fast postoperative recovery, low recurrence rate and safe.