三维腹腔镜手术联合醋酸亮丙瑞林治疗盆腔深部浸润型子宫内膜异位症疗效观察

Efficacy of Three-Dimensional Laparoscopic Surgery Combined with Leuprorelin Acetate Microspheres for Injection in the Treatment of Deep Infiltrating Endometriosis

目的探讨三维(3D)腹腔镜手术联合促性腺激素释放激素激动剂(GnRH-a)治疗盆腔深部浸润型子宫内膜异位症(DIE)的疗效。方法选取医院2015年7月至2018年7月收治的行3D腹腔镜手术患者110例,分为观察组和对照组,各55例。观察组予皮下注射醋酸亮丙瑞林微球治疗,对照组予孕三烯酮治疗,均持续治疗6个月。结果术后6个月,观察组治疗总有效率为94.55%,显著高于对照组的81.82%(P<0.05);术后6个月,两组患者雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)、丙二醛(MDA)、活性氧(ROS)、骨桥蛋白(OPN)、基质金属蛋白酶9(MMP-9)、金属蛋白酶组织抑制物1(TIMP-1),MMP-9/TIMP-1水平均较术前显著下降,超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)水平均较术前显著升高(P<0.05);观察组患者痛经及盆腔痛缓解率显著高于对照组(P<0.05),而性交痛缓解率无显著差异(P>0.05)。用药6个月期间,两组患者药品不良反应发生率无显著差异(9.09%比12.73%,P>0.05);随访12个月期间,两组患者复发率、妊娠率差异显著(P<0.05)。结论3D腹腔镜联合GnRH-a治疗DIE,疗效显著,可改善患者的内分泌功能及氧化应激状态,抑制相关肿瘤因子,缓解疼痛,安全性较高,且可减少术后复发,提高妊娠率。

Objective To investigate the efficacy of three-dimensional(3 D)laparoscopic surgery combined with gonadotropin-releasing hormone agonist(GnRH-a)in the treatment of pelvic deep infiltrating endometriosis(DIE).Methods Totally 110 patients underwent3 D laparoscopic surgery in our hospital from July 2015 to July 2018 were selected and divided into the observation group and the control group,55 cases in each group.The patients in the observation group were injected with Leuprorelin Acetate Microspheres for Injection,while the patients in the control group were treated with gestrinone.Both groups were continuously treated for 6 months.Results Six months after surgery,the total effective rate of the observation group was 94.55%,which was significantly higher than81.82%of the control group(P<0.05).The levels of estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),malondialdehyde(MDA),reactive oxygen species(ROS),osteopontin(OPN),matrix metalloproteinase-9(MMP-9),tissue inhibitor of metalloproteinase-1(TIMP-1)and MMP-9/TIMP-1 in the two groups were significantly decreased compared with those before surgery,while the levels of superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)were significantly increased compared with those before surgery(P<0.05).The relief rate of dysmenorrhea and pelvic pain in the observation group was significantly higher than that in the control group(P<0.05),while the relief rate of sexual intercourse pain was not different between the two groups(P>0.05).There was no statistically significant difference in the incidence of adverse drug reactions between the two groups during 6 months of medication(9.09%vs.12.73%,P>0.05).During 12 months of follow-up,there were significant differences in the recurrence rate and pregnancy rate between the two groups(P<0.05).Conclusion 3 D laparoscopy combined with GnRH-a is effective and safe in the treatment of patients with DIE,and it can significantly improve endocrine function and oxidative stress,inhibit tumor-related factors,relieve pain,and it can reduce postoperative recurrence and improve pregnancy rate.