不同药物联合宫腹腔镜术对不孕症合并早中期子宫内膜异位症疗效比较

Comparison of efficacy of different drugs combined with laparoscopic and hysteroscopic surgery for treating infertility women with early and middle stage of endometriosis

目的:探讨不同药物联合宫腹腔镜探查手术治疗不孕症合并早中期(Ⅰ、Ⅱ期)子宫内膜异位症(EMs)的临床效果。方法:收集2016年1月-2018年月1月在本院就诊的不孕症患者120例,均行宫腹腔镜术,切除病灶病理证实为Ⅰ~Ⅱ期EMs患者。根据术后用药不同分为两组,分别使用屈螺酮炔雌醇(Ⅱ)和孕三烯酮治疗3个月。术后随访1~1.5年,比较两组临床症状改善情况及妊娠结局。结果:两组术后第3个月CA125水平和视觉模糊评分(VAS)均较同组术前下降(P<0.05),但两组比较无明显差异(P>0.05)。两组术后3个月血清FSH、E2及AMH水平均较术前无明显变化,且两组亦无明显差异(P>0.05)。屈螺酮炔雌醇组妊娠率(72.2%)高于孕三烯酮组(51.6%)(P<0.05)。发生药物不良反应屈螺酮炔雌醇组(7.5%)低于孕三烯酮组(22.2%)(P<0.05)。结论:不孕症合并早中期EMs患者行宫腹腔镜手术后联合屈螺酮炔雌醇或孕三烯酮治疗均有较好治疗效果,但屈螺酮炔雌醇(Ⅱ)可获得更高的妊娠率及更少的药物不良反应。

Objective: To explore the clinical effect of different drugs combined with laparoscopic and hysteroscopic surgery for treating infertility women with Ⅰ and Ⅱ stage of endometriosis(EMs). Methods: The infertility women with Ⅰ and Ⅱ stage of endometriosis by intraoperative pathology after standard laparoscopic and hysteroscopic surgery were included in the study from January 2016 to January 2018. These women were randomly divided into two groups according to different postoperative medication. The women in group A had received drospirenone Ⅱ tablets for three months and the women in group B had received gestrinone tablets for three months. Postoperative followed up was conducted for 1-1.5 years to compare the improvement of postoperative clinical symptoms and pregnancy outcomes of the women in the two groups. Results: The postoperative CA125 level and VAS scores of the women in the two groups had decreased significantly(P<0.05), but which had no significant different between the two groups(P>0.05). The serum levels of FSH, E2 and AMH the women in the two groups 3 months after the operation had no significant changed significantly(P<0.05), and which had also no significant different between the two groups(P>0.05). The pregnancy rate(72.2%) of the women in group A was significant higher than that(51.6%) of the women in group B, but the adverse drug reaction of the women in group A was(7.5%), which was significant lower than that(22.2%) of the women in group B(P<0.05). Conclusion: The clinical effect of laparoscopic and hysteroscopic surgery combined with drospirenone Ⅱ or gestrinone for treating infertility women with early and middle stage endometriosis is good, and drospirenone Ⅱ can improve their pregnancy rate and reduce the drug adverse reaction rate.