腹腔镜手术联合曲普瑞林治疗轻度子宫内膜异位症并不孕临床观察

Clinical Observation on Laparoscopic Surgery Combined with Triptoreline in the Treatment of Mild Endometriosis Complicated with Infertility

目的探讨腹腔镜手术联合促性腺激素释放激素激动剂(GnRH-a)曲普瑞林治疗子宫内膜异位症(EMS)并不孕的临床疗效。方法选取医院2014年1月至2016年12月经腹腔镜手术确诊的EMS并不孕患者182例,按术后治疗方案的不同分为期待组(53例)、促孕组(71例)和GnRH-a组(58例)。期待组患者不采用药物治疗,促孕组患者予枸椽酸氯米芬胶囊,GnRH-a组患者予醋酸曲普瑞林注射液,疗程均为3个月,随访6个月。结果促孕组及GnRH-a组的总有效率分别为88.73%和94.83%,显著高于期待组的79.25%(P<0.05);GnRH-a组复发率为5.17%,显著低于期待组的20.75%(P<0.05);与术前比较,3组患者术后3个月的视觉模拟评分(VAS)及Kupperman评分均显著降低(P<0.05),促孕组患者血清卵泡刺激素(FSH)、黄体生成素(LH)及雌二醇(E2)水平均显著升高,GnRH-a组患者的FSH,LH,E2水平均显著降低(P<0.05);GnRH-a组总妊娠率为43.10%,显著高于期待组的26.42%和促孕组的39.44%(P<0.05)。结论腹腔镜手术联合GnRH-a治疗EMS并不孕可有效减轻疼痛症状,降低术后复发率,改善生育能力。

Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin-releasing hormone agonist(GnRH-a)triptoreline in the treatment of mild endometriosis(EMS)complicated with infertility.Methods Totally 182 patients with EMS complicated with infertility diagnosed by laparoscopic surgery in our hospital from January 2014 to December 2016 were selected and divided into the expectation group(n=53),progestational group(n=71)and GnRH-a group(n=58)according to the postoperative treatment regimens.The patients in the expectation group were not treated with drugs,those in the pro-pregnancy group were given Clomiphene Citrate Capsules,and those in the GnRH-a group were given Triptoreline Acetate Injection.The course of treatment was 3 months,and the patients were followed up for 6 months.Results The total effective rates of progestational group and GnRH-a group were 88.73%and 94.83%,which were significantly higher than 79.25%of the expectation group(P<0.05),the recurrence rate of the GnRH-a group was 5.17%,which was significantly lower than 20.75%of the expectation group(P<0.05).Compared with those before operation,the visual analogue scale(VAS)score and Kupperman score in the three groups were significantly decreased in 3 months after operation(P<0.05),the levels of serum follicle-stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)in the progestational group were significantly increased,while the levels of FSH,LH and E2 in the GnRH-a group were significantly decreased(P<0.05).The total pregnancy rates of the GnRH-a group was 43.10%,which was significantly higher than 26.42%of the expectation group and 39.44%of the progestational group(P<0.05).Conclusion Laparoscopic surgery combined with GnRH-a in the treatment of EMS complicated with infertility can effectively alleviate pain symptoms,reduce the recurrence rate and improve fertility.