孕三烯酮联合宫腹腔镜对不孕症合并子宫内膜异位症的治疗效果

Application effect of gestrinone combined with hysteroscopy and laparoscopy in patients with infertility and endometriosis

目的:探讨孕三烯酮联合宫腹腔镜对不孕症合并子宫内膜异位症(EMs)患者的治疗效果。方法:选取134例不孕症合并EMs患者为研究对象,根据治疗方式不同分为观察组(n=68)和对照组(n=66)。患者行宫腹腔镜手术后,观察组口服孕三烯酮治疗,对照组口服屈螺酮炔雌醇治疗。比较两组患者相关参数指标及妊娠结局。结果:治疗后1年,观察组自然妊娠率高于对照组(P<0.05);水肿、肠胃不适发生率及不良反应总发生率低于对照组(P<0.05)。治疗后3、6个月,两组患者的累及妊娠率、1年内EMs复发率及血压升高、肝功能异常、痤疮等不良反应发生率比较,差异无统计学意义(P>0.05)。术后3、6、12个月,观察组患者子宫内膜厚度大于对照组(P<0.05)。术后3个月,观察组患者血清糖类抗原125(CA125)、糖类抗原199(CA199)、子宫内膜抗体(EMAb)及γ型干扰素(IFN-γ)水平低于对照组(P<0.05);血清白细胞介素-4(IL-4)浓度高于对照组(P<0.05)。结论:宫腹腔镜联合孕三烯酮治疗,能更好改善不孕症合并EMs患者的炎症反应及临床症状,提高患者的自然妊娠率,且药物不良反应少于屈螺酮炔雌醇联合治疗,值得临床推广。

Objective:To explore the curative effect of gestrinone combined with hysteroscopy and laparoscopy in the treatment of patients with infertility and endometriosis(EMs).Methods:A total of 134 patients with infertility and EMs were enrolled.They were divided into observation group(n=68)and control group(n=66)by different treatment methods.Both groups underwent hysteroscopy.After surgery,observation group was treated with gestrinone,while control group was treated with drospirenone ethinyl estradiol.The related parameters and pregnancy outcomes between the two groups were compared.Results:The natural pregnancy rate in observation group was higher than that in control group at 1 year after treatment(P<0.05).The incidences of edema and gastrointestinal discomfort,and the total incidence of adverse reactions in observation group were lower than those in control group(P<0.05).There was no significant difference in cumulative pregnancy rate at 3 and 6 months after treatment,recurrence rate of EMs within 1 year,or the incidence of adverse reactions(elevation of blood pressure,abnormal liver function,acne)between the two groups(P>0.05).At 3,6,and 12 months after surgery,endometrial thickness in observation group was higher than that in control group(P<0.05).At 3 months after surgery,levels of serum carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),antiendometrial antibody(EMAb)and interferonγ(IFN-γ)in observation group were lower than those in control group(P<0.05),while concentration of serum interleukin-4(IL-4)was higher than that in control group(P<0.05).Conclusion:Hysteroscopy combined with gestrinone can significantly improve inflammatory response and clinical symptoms in patients with infertility and EMs,and significantly increase natural pregnancy rate.The adverse drug reactions caused by hysteroscopy combined with gestrinone are also lower than those by hysteroscopy combined with drospirenone ethinyl estradiol,which is worthy of clinical promotion.