GnRHa联合反向添加戊酸雌二醇对重度子宫内膜异位症腹腔镜术后患者的疼痛感及远期复发率影响

Influence of GnRHa plus add back estradiol valerate on pain and recurrence rate in patients with severe endometriosis after laparoscopic surgery

目的探讨促性腺激素释放激素激动剂（gonadotropin releasing hormone agonist,GnRHa）联合反向添加戊酸雌二醇片对重度子宫内膜异位症腹腔镜术后患者的疼痛感及远期复发率的影响效果。方法选取2011年12月~2013年12月在武汉康健妇婴医院妇产科经腹腔镜手术治疗的120例重度子宫内膜异位症患者为研究对象,采用随机数字表法分为GnRha组与反向添加组。GnRHa组予皮下注射亮丙瑞林针（GnRha）3.75 mg,间隔28 d注射1次,共3次。反向添加组患者在对照组基础上联合戊酸雌二醇片,比较2组患者疼痛改善程度、术后复发、副作用情况。结果治疗后,反向添加组与GnRHa组患者的VAS评分均下降,且反向添加组患者治疗后VAS评分更低（P〈0.05）。术后1年,反向添加组患者复发率与GnRHa组比较差异无统计学意义（5.00%vs.3.33%;χ~2=0.209,P=0.756）,术后2年,2组复发率比较差异无统计学意义（10.00%vs.11.67%;χ~2=0.086,P=0.913）。反向添加组患者不良反应发生率显著低于GnRHa组（23.33%vs.46.67%;χ~2=7.179,P〈0.05）。结论 GnRHa可以缓解重度子宫内膜异位症腹腔镜术后患者的疼痛感,降低远期复发率,反向添加戊酸雌二醇后不影响治疗效果,并且可以降低不良反应。

Objective To explore the effect of gonadotropin releasing hormone agonist（ GnRHa） combined with add back estradiol valerate on pain and recurrence rate in patients with severe endometriosis after laparoscopic surgery. Methods 120 cases undergoing laparoscopic surgery of severe endometriosis patients were selected from December 2011 to December 2013 in obstetrics and gynecology department of our hospital,and divided to GnRha group and add-back group with random digital table method. GnRha group received 3. 75 mg leuprorelin（ GnRha） of subcutaneous injection,the injection interval for 28 days,a total of three times. The add-back group received estradiol valerate on the basis of control group. The improvement of pain,postoperative recurrence rate and adverse reactions between two group were compared. Results After treatment,the VAS score in add-back group and GnRHa group decreased,and VAS in add-back group was lower than GnRHa group（ P〈0. 05）. There was no significant difference in recurrence rate after surgery of the first year and the second year in add-back group and GnRHa group（ 5. 00% vs. 3. 33%,χ~2= 0. 209,P = 0. 756; 10. 00%vs. 11. 67%; χ~2= 0. 086,P = 0. 913）. The adverse reactions in add-back group was lower than GnRHa group（ 23. 33% vs. 46. 67%; χ~2= 7. 179,P〈0. 05）. Conclusion GnRHa could relieve the pain of severe endometriosis after laparoscopic surgery and reduce long-term recurrence rate. The add back estradiol valerate dose not affect the efficacy,and could reduce the adverse reactions.