子宫内膜异位症腹腔镜手术后应用促性腺激素释放激素类似物及反加疗法的疗效观察

Observation on the curative effect of GnRHa combined with add- back therapy for endometriosis after laparoscopy

目的探讨子宫内膜异位症腹腔镜手术后应用促性腺激素释放激素类似物(GnRHa)及反加疗法的临床疗效。方法选取南华大学附属第一医院收治的72例子宫内膜异位症患者作为研究对象,根据治疗方法的不同分为3组,对照组采用腹腔镜保守治疗,GnRHa组于腹腔镜手术后应用醋酸亮丙瑞林微球治疗,反向添加组在GnRHa组基础上每日应用雌二醇屈螺酮片,连续治疗3个周期。比较3组治疗前后Kupperman评分、VAS疼痛评分及临床疗效。结果治疗后,GnRHa组Kupperman评分显著高于反向添加组及对照组,差异有统计学意义(P<0.05);GnRHa组及反向添加组VAS评分均显著低于对照组,差异有统计学意义(P<0.05)。治疗后,GnRHa组潮热出汗、失眠、性生活障碍、骨痛及性格改变的发生率均显著高于反向添加组及对照组,差异有统计学意义(P<0.05)。GnRHa组及反向添加组复发率均显著低于对照组,差异有统计学意义(P<0.05)。结论子宫内膜异位症术后应用GnRHa及反加疗法均可显著降低患者疼痛及术后复发率,且反加疗法可以降低并发症发生率。

Objective To explore the curative effect of gonadotropin releasing hormone analogues（ GnRHa） and add- back therapy for endometriosis after laparoscopy. Methods A total of 72 cases of endometriosis admitted to the First Hospital Affiliated to Nanhua University were included in this study,then they were divided into 3 groups according to different therapies. The cases in control group received conservative laparoscopic treatment. The cases in GnRHa group received leuprolide acetate microsphere treatment following laparoscopy. The cases in add- back group received estradiol and drospirenone tablets for consecutive 3 courses of treatment on the basis of GnRHa group. Kupperman scores,VAS pain scores and clinical effects of the three groups were compared. Results After treatment,Kupperman score in GnRHa group was statistically significantly higher than those in add- back group and control group（ P〈0. 05）. VAS scores in GnRHa group and add- back group were statistically significantly lower than that in control group（ P〈0. 05）. The incidences of hot flashes,sweating,insomnia,sexual life disorders,ostealgia,and character change in GnRHa group were statistically significantly higher than those in add- back group and control group（ P〈0. 05）. The recurrence rates in GnRHa group and add- back group were statistically significantly lower than that in control group（ P〈0. 05）. Conclusion Postoperative application of GnRHa and add- back therapy in endometriosis can significantly reduce pain and recurrence rate,and add- back therapy can reduce the incidence of complications.