腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症疗效的比较研究

Efficacy of Laparoscopic Surgery Combined with GnRH-a in the Treatment of 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）治疗子宫内膜异位症的临床疗效。方法回顾性分析我院2008年1月~2012年1月行腹腔镜手术治疗的205例子宫内膜异位症患者资料,根据术后是否接受GnRH-a治疗及术后接受GnRH-a治疗的时间分成3组：A组单纯行腹腔镜手术（73例）,B组术后亮丙瑞林治疗3个月（68例）,C组术后亮丙瑞林治疗6个月（64例）。术后随访24个月,对比分析3组复发率及妊娠率。结果 B、C组1年内复发率分别为4.4%（3/68）、3.1%（2/64）,均低于A组13.7%（10/73）,C组显著低于A组（χ2=4.771,P=0.029）,B组与A组差异无显著性（χ2=3.628,P=0.057）;B、C组累积复发率分别为13.2%（9/68）、10.9%（7/64）,显著低于A组27.4%（20/73）（χ2=4.322,P=0.038;χ2=5.839,P=0.016）。3组术后2年内自然妊娠率差异无显著性（χ2=0.812,P=0.666）,体外受精-胚胎移植（IVF-ET）妊娠者,B、C两组妊娠率[78.9%（15/19）、80.0%（16/20）]明显高于A组47.6%（10/21）（χ2=4.177,P=0.041;χ2=4.630,P=0.031）。结论腹腔镜联合GnRH-a治疗子宫内膜异位症疗效满意,可有效降低复发率,对腹腔镜术后行IVF-ET者于术后应用3~6个月GnRH-a可提高妊娠率。

Objective To evaluate the clinical efficacy of laparoscopic surgery combined with GnRH agonist in the treatment of endometriosis.Methods From January 2008 to January 2012,205 patients with endometriosis underwent conservative laparoscopy surgery in our hospital.According to whether the patients accepted the therapy of GnRH-a and the time of the treatment after surgery,patients were divided into three groups：group A was treated with conservative laparoscopic surgical（73 cases）,group B was given GnRH-a for 3 months after surgery（68 cases）,and group C received GnRH-a for 6 months after surgery（64 cases）.These patients were followed up for 24 months after surgery.The recurrence rate and pregnancy rate were compared among the three groups.Results The postoperative recurrence rates within one year were 4.4%（3 /68） in the group B and 3.1%（2 /64） in the group C,which were all lower than that of the group A（13.7%,10 /73）.There was no difference between the group A and B（χ2= 3.628,P = 0.057）,while the rate of group C was significantly lower than that of the group A（χ2= 4.771,P = 0.029）.The cumulative recurrence rates in the group B and C were respectively 13.2%（9 /68） and 10.9%（7 /64）,which were significantly lower than that of the group A [27.4%（20 /73）; χ2= 4.322,P = 0.038; χ2= 5.839,P = 0.016].There were no differences about the natural pregnancy rate within 2 years postoperatively among the three groups（χ2= 0.812,P = 0.666）,but for those who underwent IVF-ET after laparoscopy,the pregnancy rates in group B and C were respectively 78.9%（15 /19） and 80.0%（16 /20）,which were significantly higher than that of the group A [47.6%（10 /21）; χ2= 4.177,P = 0.041; χ2= 4.630,P = 0.031].Conclusions Laparoscopic surgery combined with GnRH-a is highly effective in the treatment of endometriosis,which can effectively reduce the recurrence rate.Application of GnRH-a for 3-6 months after laparoscopic surgery can improve the pregnancy rate in those who accept the treatment of IVF-ET.