腹腔镜治疗子宫内膜异位症术后应用GnRHa对妊娠的影响

Effect of GnRHa on pregnancy for post-laparoscopy patient with endometriosis

目的：探讨腹腔镜术后应用药物治疗有生育要求的子宫内膜异位症（ EMs）对妊娠的影响。方法84例在陕西省妇幼保健院行腹腔镜下卵巢囊肿剥除术后确诊为EMs并排除输卵管因素及男方因素的不孕症患者，随机分为促性腺素释放激素激动剂（GnRHa）组42例和孕三烯酮组42例。 GnRHa组于术后第1次月经来潮第1天给予GnRHa（达菲林3．75mg）肌内注射，每28天1次，共3次；GnRHa组于术后第1次月经来潮第1天口服孕三烯酮片2．5mg，每周2次，连续3个月。两组均于停药恢复月经后口服克罗米芬诱发排卵共1～6周期，于月经周期第5天起口服克罗米芬5mg／日，共5天，同时口服补佳乐1mg／日，共10天（若妊娠终止促排卵治疗）。观察两组患者术后治疗3个月及术后9月（即停药后6个月）后妊娠情况、痛经及复发率情况。结果 GnRHa组术后3个月，术后9个月（即停药6个月）临床累积妊娠率均高于孕三烯酮组，差异有统计学意义（χ^2值分别为5．845、10．720，均P＜0．05）。 GnRHa组术后3个月，术后9个月（即停药6个月）痛经复发率均低于孕三烯酮组，差异有统计学意义（χ2值分别为6．462、12．07，均P＜0．05）。结论腹腔镜治疗有生育要求的EMs患者术后应用GnRHa治疗可提高术后妊娠率；延长EMs的复发时间。

Objective To explore the effect of pharmacotherapy on pregnancy for post-laparoscopy patients with endometriosis （ EMs ） . Methods Totally 84 infertile patients with confirmed diagnosis of EMs following laparoscopic operations of ovarian cyst stripping in Shaanxi Maternal and Child Care Service Centre were selected.Fallopian and male factors for infertility were excluded.Patients were randomly allocated to gonadotropin-releasing hormone agonist （ GnRHa） group （42 patients） and gestrinone group （42 patients） .GnRHa group was given intramuscular injection of GnRHa （3.5mg of diphereline） on the first day during their first menstruation after operation and then injected once every 28 days and 3 times in total, while gestrinone group took 2.5mg of gestrinone orally on the first day during their first menstruation after operation and then took them orally twice a week for 3 months.After discontinuation of pharmacotherapy and restoration of menstruation, both groups took clomiphene to induce ovulation for a total of 1-6 cycles, and then they took 5mg of clomiphene per day for 5 days from the fifth day of menstruation and took 1mg of progynova orally every day for 10 days （ stop ovulation induction if gravidity appeared） .The pregnancy, dysmenorrheal and recurrence rate during the 3-month-treatment and 9 months after operation （6 months after drug withdrawal） were observed in two groups.Results The clinical accumulated pregnancy rates of GnRHa group in first three and nine months after operation （ namely six months after discontinuation） were higher than those of gestrinone group,and there was statistically difference （χ2 value was 5.845 and 10.720, respectively, both P〈0.05）.The dysmenorrhea recurrence rate in first three and nine months after operation （ namely six months after discontinuation ） was lower than that of gestrinone group, and the difference was statistically significant （χ2 value was 6.462 and 12.07, respectively, both P 〈0.05）.Conclusion For post-laparoscopy patients with endometriosis （EMs） who have birth demands, GnRHa therapy can significantly improve postoperative pregnancy rate and prolong the recurrence time of EMs.