子宫内膜异位症腹腔镜手术治疗后两种方案巩固治疗的效果比较

目的探讨促性腺激素释放激素激动剂（GnRH—a）注射6个月方案和促性腺激素释放激素激动剂（GnRH-a）注射3个月＋孕三烯酮口服3个月两种方案治疗子宫内膜异位症腹腔镜手术后巩固治疗的效果。方法选择2013年5月至2014年5月112例重度子宫内膜异位症患者为观察对象，根据入院时间随机分为观察组和对照纽，每纽各56例。两组患者均行腹腔镜手术治疗，对照组给予GnRH-a皮下注射6个月，观察组给予GnRH—a皮下注射3个月后改用孕三烯酮胶囊口服3个月。比较两种方案治疗后患者的疼痛程度、复发率及自然妊娠率、药物不良反应。结果两种方案治疗6个月后，两组患者VAS评分均较治疗前明显下降（t=7．504、6．740，P〈0．05），两组间比较无统计学意义（t=1．864，P〉0．05）；随访2年，两组B超新见异位囊肿、CA125异常、复发率及自然妊娠率比较差异均无统计学意义（x^2=0．156-0．439，P〉0．05）；观察组肝功能异常、不规则阴道出血明显高于对照组，骨质疏松明显低于对照组（19．64％vs5．36％，25．00％vs7．14，000％vs7．14％）（x^2=5．224，6．619，4．418，P〈0．05）。结论子宫内膜异位症腹腔镜手术后给予促性腺激素释放激素激动剂治疗6个月与促性腺激素释放激素激动剂注射3个月＋孕三烯酮胶囊口服两种方案比较，均能取得较好的治疗效果，前者应注意骨质疏松症的发生，后者需预防肝功能损伤及子宫不规则出血。

Objective To explore the efficacy of combined using gonadotropin releasing hormone agonist （ GnRH-a ） for 6 months group and gonadotropin-releasing hormone agonist （ GnRH-a ） with gestrinon 3 months group in the treatment of endometriosis after laparoscopic surgery. Methods May 2013-May 2014 112 cases of 56 cases of severe endometriosis patients in this study, according to the time of admission the use of odd and even things that were randomly divided into observation group and control group. All patients underwent laparoscopic surgery control group received GnRH-a subcutaneous injection of 6-month observation group received GnRH-a subcutaneously three months after the switch to oral capsules gestrinone 3- months. Comparison of the degree of pain, recurrence rate and natural pregnancy, adverse drug reactions. Results After 6 months of treatment, both groups VAS scores were significantly decreased （ t=7.504, 6.740, P〈0.05 ） , between the two groups there was not statistically significant （ t=-1.864, P〉0.05 ） ; after following up for 2 years, there was no statistical difference in occurrence of newcysts detected by ultrasound, CA125 abnormality, relapse rate and natural pregnancy rate （ x^2=0.156-0.439, P〉0.05 ） ; observation of abnormal liver function, irregular vaginal bleeding was significantly higher in the control group, osteoporosis was significantly lower than the control group （ 19.64% vs 5.36%, 25.00% vs 7.14, 0.00% vs 7.14% ） （ x^=5.224, 6.619, 4.418, P〈0.05 ） . Conclusions GnRH-a （ three months ） combined with Gestrlnone （ three months ） is as effective as GnRH-a （ six months ） in the treatment of endometriosis after laparoscopic surgery. Attention should be paid to the former for the prevention of liver dysfunction and irregular vaginal bleeding and the latter for osteoporosis.