GnRH-a联合腹腔镜手术治疗卵巢子宫内膜异位囊肿对患者血清性激素和卵巢基质血流的影响

Effects of gonadotropin-releasing hormone agonist combined with multi-port laparoscopic surgery for treating patients with ovarian endometriosis cyst on their serum sex hormones levels and the blood flow of ovarian stromal

目的:探讨多孔腹腔镜手术后辅以GnRH-a治疗卵巢子宫内膜异位囊肿(OEC)疗效,并分析对患者性激素、基质血流的影响。方法:选取2020年12月-2021年12月诊治的116例OEC患者,随机分为观察组和对照组各58例,两组均采用多孔腹腔镜腹腔镜手术治疗,观察组术后联合GnRHa治疗,比较两组月经正常、恢复排卵和OEC复发、雌二醇(E_(2))、孕酮(P)、卵泡刺激素(FSH)、卵巢舒张末期最低血流(EDV)、收缩期峰速(PSV)、阻力指数(RI)以及免疫功能指标CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)。结果:治疗后观察组月经正常(86.2%)、恢复排卵比例(82.8%)均高于对照组(67.2%、62.1%),OEC复发率(6.9%)低于对照组(20.7%),E_(2)(104.31±11.28 pmol/L)、P(0.33±0.09 nmol/L)水平低于对照组(123.96±13.26 pmol/L、0.64±0.13 nmol/L),FSH(10.32±1.91 mIU/ml)水平高于对照组(8.76±1.53 mIU/ml),EDV(4.13±0.68 cm/s)、PSV(14.27±1.96 cm/s)水平高于对照组(3.09±0.53 cm/s、10.52±1.55 cm/s),CD4^(+)、CD4^(+)/CD8^(+)水平低于对照组,CD8^(+)水平高于对照组(均P<0.05)。结论:多孔腹腔镜手术后联合GnRH-a治疗OEC患者效果提高,可通过调节患者性激素水平、改善基质血流和免疫功能,进而促进月经和排卵正常,降低复发率。

Objective:To investigate the efficacy of gonadotropin-releasing hormone agonist(GnRH-a)combined with multi-port laparoscopic surgery for treating patients with ovarian endometriosis cyst(OEC),and to study its influence on the serum sex hormones levels and the blood flow of ovarian stromal of these patients.Methods:A totalof 116 patients with OEC were enrolled as the research objects between December 2020 and December 2021.According to random number table method,these patients were divided into observation group and control group(58 cases in each group).The patients in the control group were treated with multi-port laparoscopic surgery,while the patients in the observation group were treated with GnRH-a additionally.The rates of normal menstruation,ovulation recovery,and recurrence of OEC,the levels of estradiol(E_(2)),progesterone(P),and follicle-stimulating hormone(FSH),the values of end-diastolic velocity(EDV),peak systolic velocity(PSV),and resistance index(RI)of ovarian,and the levels of immune function indexes,such as CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)of the patients were compared between the two groups.Results:After treatment,the proportions of normal menstruation(86.2%)and ovulation recovery(82.8%)of the patients in the observation group were significantly higher than those(67.2% and 62.1%)of the patients in the control group,and the rate recurrence of OEC(6.9%)of the patients in the observation group was significantly lower than that(20.7%)of the patients in the control group.The levels of E_(2)(104.31±11.28 pmol/L)and P(0.33±0.09 nmol/L)of the patients in the observation group were significantly lower than those(123.96±13.26 pmol/L and 0.64±0.13 nmol/L)of the patients in the control group.The level of FSH(10.32±1.91 mIU/ml)of the patients in the observation group was significantly higher than that(8.76±1.53 mIU/ml)of the patients in the control group.The values of EDV(4.13±0.68 cm/s)and PSV(14.27±1.96 cm/s)of the patients in the observation group were significantly higher than those(3.09±0.53 cm/s and 10.52±1.55 cm/s)of the patients in the control group.The levels of CD4^(+)and CD4^(+)/CD8^(+)of the patients in the observation group were significantly lower than those of the patients in the control group,and the CD8^(+)level of the patients in the observation group was significantly lower(all P<0.05).Conclusion:The curative effect of GnRH-a combined with multi-port laparoscopic surgery for treating patients with OEC is higher,which can improve their stromal blood flow and immune function by regulating the levels of sex hormones,thereby promoting menstruation normal and ovulation recovery,and reducing the recurrence rate of OEC.