腹腔镜子宫腺肌病病灶切除联合GnRH-a治疗的对比研究

Comparative Study of Laparoscopic Adenomyomectomy Combined with GnRH-a Treatment for Uterine Adenomyosis

目的：探讨腹腔镜子宫腺肌病病灶切除术联合促性腺激素释放激素激动剂（GnRH-a）治疗子宫腺肌病的疗效。方法回顾性分析2009年1月～2013年5月我院79例行腹腔镜子宫腺肌病病灶切除术患者的临床资料，其中手术联合药物组（A 组）42例，术后第3天皮下注射亮丙瑞林6个疗程（28天一次），单纯手术组（B 组）37例，比较2组治疗后痛经、月经量、子宫体积的变化。结果2组治疗后痛经分级降低（F ＝342．967，P ＝0．000），月经量评分降低（F ＝135．743，P ＝0．000），子宫体积缩小（F ＝393．341，P ＝0．000）。与 B 组相比，A 组痛经分级和月经量评分降低明显（F ＝14．274，P ＝0．000，F ＝18．222， P ＝0．000），子宫体积明显缩小（F ＝30．692，P ＝0．000）。随访12～64个月，（30．3±10．3）月，A 和 B 组的有效率分别为81．0％（34／42）、62．2％（21／37）（log-rank χ2＝4．915，P ＝0．027）。结论腹腔镜子宫腺肌病病灶切除联合 GnRH-a 治疗能更有效地控制患者的临床症状，减少复发。

Objective To discuss the effect of laparoscopic adenomyomectomy combined with gonadotropin-releasing hormone agonist （GnRH-a）administration in the treatment of uterine adenomyosis. Methods Clinical data of 79 patients with uterine adenomyosis from January 2009 to May 2013 were collected.The patients of group A （42 cases）were given triptorelin for 6 courses after laparoscopic adenomyomectomy,whereas the patients of group B （37 cases）underwent laparoscopic adenomyomectomy alone. The dysmenorrhea,the menstrual amount and the uterine volume were analyzed. Results After treatment,the dysmenorrhea grade, the menstrual volume score and the uterine volume of the two groups were all significantly decreased （F =342.967,P =0.000;F =135.743,P =0.000;F =393.341 ,P =0.000 ）.The dysmenorrhea grade and menstrual volume score in the group A were statistically lower than those in the group B （F =14.274,P =0.000;F =18.222,P =0.000）.The uterine volume in the group A was smaller than that in the group B （F =30.692,P =0.000）.The effect rates of group A and group B during follow-up were 81 .0%（34 /42 ） and 62.2% （21 /37 ）,respectively （χ2 =4.915,P =0.027 ）. Conclusions Laparoscopic adenomyomectomy can effectively used for uterine adenomyosis.Combined with GnRH-a after adenomyomectomy,the method is more effective in controlling symptoms and reducing disease recurrence.