腹腔镜术后促性腺激素释放激素激动剂、反加疗法联合坤泰胶囊在子宫内膜异位症中的应用效果

Application efficacy of gonadotropin-releasing hormone agonist,add-back therapy combined with Kuntai Capsules in endometriosis after laparoscopy

目的探讨腹腔镜术后促性腺激素释放激素激动剂(GnRH-a)、反加疗法联合坤泰胶囊在子宫内膜异位症(EM)中的应用效果。方法将行腹腔镜保守手术治疗的267例EM患者,根据术后治疗方法分为对照组(158例)和坤泰胶囊组(109例)。对照组给予GnRH-a、反加疗法治疗,坤泰胶囊组在对照组治疗基础上给予坤泰胶囊治疗,两组均治疗3个月。比较两组治疗前后的疼痛视觉模拟量表(VAS)评分、生活质量评分、性激素和糖类抗原125(CA125)水平,以及治疗后临床疗效、复发情况、不孕者妊娠情况。记录治疗期间不良反应发生情况。结果治疗后,两组VAS评分及生活质量评分均较治疗前改善,且坤泰胶囊组的评分均优于对照组(均P<0.05);两组外周血CA125、抗苗勒管激素、促卵泡激素、黄体生成素及雌二醇水平均较治疗前降低,且与对照组比较,坤泰胶囊组CA125水平更低而雌二醇水平更高(均P<0.05)。坤泰胶囊组治疗期间头晕、潮热盗汗和失眠发生率低于对照组,而治疗后0~6个月内合并不孕症患者妊娠率高于对照组(均P<0.05)。两组疗效及治疗后1年复发率差异无统计学意义(均P>0.05)。结论腹腔镜术后在GnRH-a联合反加疗法的基础上,应用坤泰胶囊可更有效地减轻EM患者疼痛,改善子宫内膜容受性以提高自然妊娠率,并可通过维持雌激素水平来减轻GnRH-a所致的不良反应。

Objective To investigate the application efficacy of gonadotropin-releasing hormone agonist(GnRH-a),add-back therapy combined with Kuntai Capsules in endometriosis(EM)after laparoscopy.Methods A total of 267 EM patients who underwent laparoscopic conservative surgery were divided into control group(158 cases)and Kuntai Capsules group(109 cases)according to the postoperative therapeutic approach.The control group received GnRH-A and add-back therapy,while the Kuntai Capsules group was given Kuntai Capsules on the basis of the therapy in the control group,both groups were treated for three months.Pre-and posttreatment Visual Analogue Scale(VAS)pain scores,quality of life scores,sex hormone and carbohydrate antigen 125(CA125)levels,as well as posttreatment clinical efficacy,incidence of recurrence and pregnancy outcome of infertile women were compared between the two groups.The incidence of adverse reactions during treatment was recorded.Results After treatment,VAS scores and quality of life scores were improved in both groups as compared with the pretreatment scores,and the Kuntai Capsules group had superior scores than the control group(all P<0.05);peripheral blood levels of CA125,anti-Mullerian hormone,follicle-stimulating hormone,luteinizing hormone and estradiol were decreased in both groups as compared with the pretreatment levels,moreover,compared with the control group,the Kuntai Capsules group exhibited a lower CA125 level and a higher estradiol level(all P<0.05).The Kuntai Capsules group had lower incidence rates of dizziness,hot flashes and night sweats,and insomnia during treatment than the control group,whereas patients complicated with infertility had a higher pregnancy rate within six months after treatment than the control group(all P<0.05).No statistically significant difference was found between the two groups in efficacy or 1-year recurrence rate postoperatively(all P>0.05).Conclusion Based on GnRH-a combined with add-back therapy,the use of Kuntai Capsules following laparoscopy can achieve pain relief more effectively in EM patients,improve their endometrial receptivity so as to increase natural pregnancy rate,simultaneously,ameliorating GnRH-a-induced adverse reactions via maintaining estrogen level.