卵巢子宫内膜异位囊肿不孕症患者腹腔镜术后联合GnRH-a治疗的有效性分析

Efficacy of Combined GnRH-a Therapy after Laparoscopic Surgery in Patients with Ovarian Endometriosis Cyst Infertility

目的:探讨卵巢子宫内膜异位囊肿不孕症患者腹腔镜术后联合GnRH-a治疗的有效性。方法:选取2018年1月-2019年8月于笔者所在医院就诊的70例卵巢子宫内膜异位囊肿合并不孕患者,根据治疗不同分为两组,对照组行腹腔镜治疗,研究组行腹腔镜治疗术后联合GnRH-a治疗。比较两组术后3、6个月时卵巢储备功能情况,月经恢复情况,比较研究组停药后半年、1年时两组复发率、妊娠率。结果:术后3个月,对照组E_(2)、FSH/LH、FSH均高于术前,AMH低于术前,差异均有统计学意义(P<0.05);研究组E_(2)、FSH/LH、FSH、AMH均低于术前,差异均有统计学意义(P<0.05);术后3个月,研究组E_(2)、FSH/LH、FSH均低于对照组,差异均有统计学意义(P<0.05),两组AMH对比差异无统计学意义(P>0.05)。术后6个月,对照组E_(2)、FSH/LH均高于术前,AMH低于术前,差异均有统计学意义(P<0.05),FSH与术前比较差异无统计学意义(P>0.05);研究组AMH低于术前,差异有统计学意义(P<0.05),E_(2)、FSH/LH、FSH与术前比较差异无统计学意义(P>0.05);术后6个月研究组E_(2)、FSH/LH均低于对照组,AMH高于对照组,差异均有统计学意义(P<0.05),FSH与对照组比较差异无统计学意义(P>0.05)。两组术前、术后经期时间、经期周期比较差异均无统计学意义(P>0.05)。研究组停药后半年、1年时,研究组复发率均低于对照组,自然妊娠率均高于对照组,差异均有统计学意义(P<0.05)。结论:卵巢子宫内膜异位囊肿不孕患者在腹腔镜治疗后联合使用GnRH-a治疗能够显著降低术后复发率,保护卵巢储备功能,使自然妊娠率获得提高,停药后对月经几乎无影响,值得临床推广。

Objective:To investigate the effectiveness of laparoscopic combined GnRH-a therapy in patients with ovarian endometriosis cyst infertility.Method:Seventy patients with ovarian endometriosis cyst complicated with infertility admitted to our hospital from January 2018 to August 2019 were selected and divided into two groups according to different treatments.The control group received laparoscopic treatment,while the research group received postoperative laparoscopic treatment combined with GnRH-a treatment.The ovarian reserve function at 3 and 6 months after surgery and menstrual recovery were compared between the two groups.The recurrence rate and pregnancy rate were compared between the two groups at 6 months and 1 year after drug withdrawal of the research group.Result:Three months after surgery,E_(2),FSH/LH and FSH in the control group were higher than those before surgery,and AMH was lower than that before surgery,the differences were statistically significant(P<0.05),E_(2),FSH/LH,FSH and AMH in the research group were all lower than those before surgery,the differences were statistically significant(P<0.05).Three months after surgery,E_(2),FSH/LH and FSH in the research group were lower than those in the control group,the differences were statistically significant(P<0.05),while there was no statistically significant difference in AMH between the two groups(P>0.05).Six months after surgery,E_(2) and FSH/LH in the control group were higher than before surgery,and AMH was lower than that before surgery,the differences were statistically significant(P<0.05),but there was no statistically significant difference in FSH compared with that before surgery(P>0.05),AMH in the research group was lower than that before surgery,the difference was statistically significant(P<0.05),there were no significant differences in E_(2),FSH/LH and FSH compared with those before surgery(P>0.05).Six months after surgery,E_(2) and FSH/LH in the research group were lower than those in the control group,while AMH was higher than that in the control group,the differences were statistically significant(P<0.05),there was no significant difference in FSH compared with control group(P>0.05).There were no significant differences in the preoperative and postoperative menstrual time and menstrual cycle between the two groups(P>0.05).The recurrence rate in the research group was lower than that in the control group,and the natural pregnancy rate was higher than that in the control group at 6 months and 1 year after drug withdrawal of the research group,the differences were statistically significant(P<0.05).Conclusion:Combined use of GnRH-a in infertile patients with ovarian endometriosis cyst after laparoscopic treatment can significantly reduce postoperative recurrence rate,protect ovarian reserve function,improve the natural pregnancy rate,and have almost no effect on menstruation after drug withdrawal,which is worthy of clinical promotion.