联合应用促性腺激素释放激素激动剂和孕三烯酮治疗子宫内膜异位症患者的预后分析

Prognosis Analysis of Gonadotropin-releasing Hormone Agonist Combined with Gestrinone after Laparoscopic Surgery Treatment for the Patients with Endometriosis

目的:探讨腹腔镜术后联合应用促性腺激素释放激素激动剂(Gn RH-a)和孕三烯酮巩固治疗子宫内膜异位症患者的临床效果,并分析其对患者卵巢功能及复发和再次妊娠的影响。方法:选取2012年1月-2014年3月在本院妇产科行腹腔镜手术治疗的子宫内膜异位症患者164例,按随机数字表法分为四组,分别为联合组38例(术后应用Gn RH-a联合孕三烯酮治疗),Gn RH-a组43例(术后仅应用Gn RH-a治疗),孕三烯酮组47例(术后仅应用孕三烯酮治疗),对照组36例(术后应用安慰剂治疗)。比较四组的症状缓解情况、用药前后性激素水平的变化、复发及再次妊娠情况。结果:联合组、Gn RH-a组、孕三烯酮组患者症状明显缓解率比较差异均无统计学意义(P>0.05),但三组均明显高于对照组,与对照组比较差异均有统计学意义(P<0.05);联合组、Gn RH-a组、孕三烯酮组用药治疗后血清雌二醇(E2)、促黄体生成素(LH)、卵泡生成素(FSH)均较治疗前明显降低,治疗前后比较差异均有统计学意义(P<0.05),联合组、Gn RH-a组上述血清性激素水平下降幅度比较差异无统计学意义(P>0.05),但均明显小于孕三烯酮组,差异有统计学意义(P<0.05);联合组、Gn RH-a组、孕三烯酮组随访期间累计复发率比较差异均无统计学意义(P>0.05),但均明显低于对照组,与对照组比较差异均有统计学意义(P<0.05);联合组、Gn RH-a组、孕三烯酮组妊娠率及良好妊娠结局率均明显高于对照组,三组与对照组比较差异均有统计学意义(P<0.05);联合组与Gn RH-a组妊娠率及良好妊娠结局率比较差异无统计学意义(P>0.05),但均明显高于孕三烯酮组,两组与孕三烯酮组比较差异均有统计学意义(P<0.05)。结论:腹腔镜术后应用Gn RH-a联合孕三烯酮治疗与单用Gn RH-a和孕三烯酮临床疗效及预防复发效果相当,对卵巢功能的影响和促进良好妊娠结局的效果与单用Gn RH-a相当,但优于单用孕三烯酮。

Objective：To discuss the clinical effect of Gonadotropin-releasing hormone agonist（Gn RH-a） combined with Gestrinone after laparoscopic surgery patients with endometriosis, and analyze the influences of the ovarian function, recurrence and pregnancy again. Method： 164 patients with endometriosis who accepted the treatment of laparoscopic surgery in our hospital were selected from January 2012 to March 2014,they were randomly divided into four groups, combinational group of 38 cases（it was treated by Gn RH-a combined with Gestrinone after laparoscopic surgery）,Gn RH-a group of 43 cases（it was only treated by Gn RH-a therapy）,gestrinone group of 47 cases（it was only treated by Gestrinone）, the control group of 36 cases（it was only treated by placebo）.The remission rate, sex hormone levels, recurrence rate, and pregnancy rate of four groups were compared.Result：Compared the remission rate of the combinational group, Gn RH-a group and Gestrinone group, the differences were not statistically significant（P〈0.05）;but the remission rate of three groups were significantly higher than that of control group, the differences were statistically significant（P〈0.05）.After treatment, the serum levels of E2,LH and FSH of combinational group, Gn RH-a group and Gestrinone group were significantly decreased than before treatment, the differences were statistically significant（P〈0.05）.Compared the change of serum levels of E2,LH and FSH in combinational group and Gn RH-a group, the differences were not statistically significant（P〈0.05）;but the change of serum levels of E2,LH and FSH in the two groups were significantly lower than that of Gestrinone group, the differences were statistically significant（P〈0.05）.Compared the recurrence rate of combinational group, Gn RH-a group and Gestrinone group, the differences were not statistically significant（P〈0.05）;but the recurrence rate of three groups were significantly lower than that of control group, the differences were statistically significant（P〈0.05）. The pregnancy rate and good rate of pregnancy outcome of combinational group, Gn RH-a group and Gestrinone group were significantly better that of control group, the differences were statistically significant（P〈0.05）;there was not significant difference of those between combinational group and Gn RH-a group（P〈0.05）,but they were significantly better than those of Gestrinone group, the differences were statistically significant（P〈0.05）.Conclusion： After laparoscopic surgery, the clinical efficacy and the prevention recurrence of Gn RH-a combined with Gestrinone,only Gn RH-a and only Gestrinone are equivalent,the effect of improving ovarian function and promoting good pregnancy outcomes of Gn RH-a combined with Gestrinone are similar with Gn RH-a, but better than only Gestrinone.