GnRH-a用于中、重度子宫内膜异位症腹腔镜手术后对妊娠的影响

Effects of GnRH-a for treating patients with moderate and severe endometriosis after laparoscopic surgery on their subseguent pregnancy

目的:探讨促性腺激素释放激素激动剂(GnRH-a)对中重度子宫内膜异位症腹腔镜术后妊娠影响。方法:选取2017年9月-2019年4月本院收治的Ⅲ、Ⅳ期子宫内膜异位症患者114例,均接受腹腔镜保守性手术治疗,按照患者意愿分为观察组和对照组,观察组术后接受GnRH-a注射3个月,随访两组术后18个月妊娠情况。结果:两组患者术后6个月时糖类抗原CA125水平、盆腔疼痛评分量表(VAS)评分均低于术前(P<0.05),但组间对比无明显差异(P>0.05);术后12个月,观察组复发率(3.5%)与对照组(7.0%)无差异(P>0.05);术后18个月妊娠率观察组(31.6%)高于对照组(14.0%)(P<0.05),两组Ⅲ期患者妊娠率无差异(P>0.05)、Ⅳ期患者妊娠率观察组(25.0%)高于对照组(3.9%)(P<0.05)。结论:中重度内异症患者腹腔镜保守性手术后应用GnRH-a,对手术效果并无明显影响,但可提高患者术后妊娠几率。

Objective:To explore the effects of gonadotropin-releasing hormone agonist(GnRH-a)for treating patients with moderate and severe endometriosis after laparoscopic surgery on their pregnancy.Methods:A total of 114 patients with stageⅢandⅣof endometriosis who had all received conservative laparoscopic surgery were selected in this study from September 2017 to April 2019.These patients were divided into observation group and control group according to their wishes.The patients in the observation group had received GnRH-a injection postoperatively,and the patients in the control group were not given GnRH-a injection postoperatively.The pregnancy status of the patients during postoperative 18 months in the two groups was followed up.Results:The CA125 level and the pelvic pain scale score of the patients in the two groups in the 6th month after operation were significantly lower than those of the patients before operation(P<0.05),but which had no significantly different between the two groups(P>0.05).There was no significant difference in the recurrence rate(3.5%vs.7.0%)of the patients in the 12th month after operation between the two groups(P>0.05).The pregnancy rate(31.6%)of the patients in the observation group in the 18th month after surgery was significantly higher than that(14.0%)of the patients in the control group(P<0.05).There was no significant difference in the pregnancy rate of the patients withⅢstage of endometriosis between the two groups(P>0.05),but the pregnancy rate(25.0%)of the patients withⅣstage of endometriosis in the observation group was significantly higher than that(3.9%)of the patients in the control group(P<0.05).Conclusion:The application of GnRH-a after laparoscopic conservative surgery of the patients with moderate and severe endometriosis has no obvious effect on the surgical effect,but can effectively increase of their pregnant rate after operation.