腹腔镜术联合药物治疗子宫内膜异位症伴不孕患者的疗效及对妊娠结局、不良反应的影响

Efficacy of laparoscopic surgery combined with medicine in the treatment of patients with endometriosis associated with infertility and its impact on pregnancy outcome and adverse reactions

目的探讨子宫内膜异位症(EMT)伴不孕患者腹腔镜手术后,联合药物治疗的疗效与安全性及对妊娠结局的影响。方法采用随机、自愿的原则,将2014年2月—2016年2月期间我院收治的拟行腹腔镜手术的78例EMT伴不孕患者,分为促性腺激素释放激素激动剂(GnRH-α)组、孕三烯酮组、对照组,各组26例,分别给予GnRH-α、孕三烯酮和常规治疗,比较三组患者术后临床疗效、妊娠结局及不良反应等情况。结果术后三组患者的临床症状均有所缓解,GnRH-α组、孕三烯酮组和对照组的总有效率分别为92.31%、88.46%、61.54%,用药组的总有效率均显著高于对照组(P<0.05),GnRH-α组与孕三烯酮组比较,差异无统计学意义(P>0.05);术后试孕一年GnRH-α组的妊娠率及足月产率均显著高于对照组(P<0.05),足月产率显著高于孕三烯酮组(P<0.05),而孕三烯酮组的妊娠率和妊娠结局与对照组比较,差异无统计学意义(P>0.05);GnRH-α组、孕三烯酮组的不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论腹腔镜术后联合药物GnRH-α或孕三烯酮治疗EMT伴不孕患者临床疗效较好,两药均能有效缓解患者症状,但GnRH-α能显著改善患者妊娠结局,无严重不良反应,安全性较高,条件允许的情况下建议选择GnRH-α进行联合药物治疗。

Objective To explore the efficacy and safety of laparoscopic surgery combined with medicine （after laparoscopic surgical procedures） in the .treatment of patients with endometriosis （EMT） complicated with infertility and its impact on pregnancy outcome. Methods Seventy-eight EMT cases complicated with infertility received laparoseopic surgery in our hospital from February 2014 to February 2016 were randomly and voluntarily allocated to the gonadotropin-releasing hormone agonist （GnRH-α） group, the gestrinone group and the control group, with 26 cases in each group, and they were given GnRH-α, gestrinone and conventional treatment, respectively. The postoperative clinical efficacy, pregnancy outcome and adverse reactions were compared among the three groups. Results The clinical symptoms of the three groups patients were relieved after operation, and the total effective rates of the GnRH-α group, the gestrinone group and the control group were 92.31%, 88.46% and 61.54%, respectively, and the total effective rate in the medication group was sig- nificantly higher than that in the control group （ P〈 0.05）, and comparing the total effective rate of the Gn- RH-α group and the gestrinone group yielded that there was no significant difference （ P 〉0.05）. Pregnancy trial for one year after operation showed that the pregnancy rate and the full-term birth rate of the GnRH-a group were significantly higher than those of the control group （ P 〈0.05）, and the full-term birth rate was significantly higher than that of the gestrinone group （ P 〈0.05）, and there were no statistically significant differences by comparing the pregnancy rate and pregnancy outcome between the gestrinone group and the control group （ P〉0.05）. There was no statistically significant difference by comparing the incidence of adverse reactions among the GnRH-α group, the gestrinone group and the control group （ P 〉0.05）. Conclusion Post-laparoscopic surgery combined with GnRH-α or gestrinone can have good clinical efficacy in treatment of EMT patients with infertility, and both medicines can effectively relieve symptoms, but GnRH-α can significantly improve the pregnancy outcome with no serious adverse reactions and with high safety. Therefore, if conditions permit, it is recommended to choose GnRH-α for combined medication therapy.