皮下埋植避孕剂缓解子宫内膜异位症患者疼痛的临床评价

Clinical Evaluation on Releasing the Pain for Endometriosis Patinets Treatmented with Subdermal Contraceptive Implant

目的研究皮下埋植避孕剂缓解子宫内膜异位症患者疼痛的临床效果。方法选择90例疑似为子宫内膜异位症的患者为研究对象,将拒绝手术治疗的60例分为皮下埋植避孕剂组(A组)和达那唑组(B组),将同意手术的30例纳入腹腔镜保守手术+Gn RH-a组(C组)。A组放置Ⅱ型皮下埋植避孕剂。B组口服达那唑胶囊,2次/日,连用6个月。C组行腹腔镜保守手术治疗后,在患者月经来潮5日内肌注达菲林3.75 mg,每隔4周一次,共6次。结果治疗前和治疗6个月后采用视觉评分法(VAS)痛经、盆腔痛、性交痛评分及月经失血图评分法(PBAC)经量评分三组内比较差异均有统计学意义(P<0.05)。治疗6个月后组间比较:C组缓解痛经疗效最佳,A组缓解盆腔痛和性交痛疗效最佳;PBAC经量评分A、B、C三组间比较,差异均无统计学意义(P>0.05)。结论皮下埋植避孕剂能有效缓解子宫内膜异位症患者的痛经、性交痛和盆腔痛,减少月经量,为不愿长期服药和拒绝手术治疗,尤其是没有生育要求的患者提供了新的选择和方法。

OBJECTIVE To evaluate the pain for endometriosis patients treatmented with subdermal contraceptive implant. METHODS 90 patients were diagnosed with endometriosis, 60 patients who refused to surgical treatment were divided into subdermal contracep- tive implant （group A）and danazol capsules（group B）. 30 patients who were willing to undergo laparoscopie surgery plus GnRH-a were divided into conservative laparoscopic surgery plus GnRH-a （group C）. Group A was implanted with subdermal contraceptive im- plant type ]1. Group B was oral danazo] capsules, 400 mg, 2times/day, continuous for 6months. Group C was treated with laparo- scopie conservative surgery and was injected intramuscularly with Dafelin 3.75 mg once every 4 weeks for 6 times in 5 days before menses. RESULTS In comparison treatment before 6 months with after 6 months, differences among group A, group B and group C are all with statisitical significance（P〈O.05） in visual analog scale（VAS） scores of dysmenorrhea, pelvic pain, sexual pain and PBAC mentrual flow score. After 6 mouths, relieve pelvic pain and sexual pain in group A was better, relieve dysmenorrhea group C was better. CONCLUSION Subdermal contraceptive implant could effectively relief the pain for endometriosis which could provide a new choice and method for patients who had no fertility requirements and refuse to long-term oral medication and surgery.