卵巢子宫内膜异位囊肿术后联合促性腺激素释放激素激动剂治疗的临床研究

Clinical study of GnRH-a treatment after operation of ovarian endometrioma

目的探讨卵巢子宫内膜异位囊肿患者行保守手术后联合促性腺激素释放激素激动剂(GnRH-a)治疗的临床疗效。方法采用回顾性队列研究方法,选取2014年12月至2018年12月在南京中医药大学附属医院妇科行卵巢子宫内膜异位囊肿保守手术的患者206例,根据术后是否联合使用GnRH-a,分为观察组138例(术后联合GnRH-a使用6个月)和对照组68例(术后未使用药物治疗)。比较两组患者术后2年内不同时间的痛经、性交痛、慢性盆腔痛评分及复发情况。结果回访2年中,观察组患者慢性盆腔痛、痛经评分优于对照组,且随时间变化差异有统计学意义(P<0.05);性交痛组间效应和时间效应差异均无统计学意义(P>0.05)。观察组患者术后第1年复发率低于对照组(3.62%vs 11.77%,P<0.05),术后第2年复发率两组比较差异无统计学意义(P>0.05),但2年累积复发率观察组低于对照组(13.24%vs 25.00%,P<0.05)。结论在子宫内膜异位症术后管理中,GnRH-a可以作为其术后疼痛管理和预防复发的药物选择。

Objective To investigate the clinical efficacy of combined gonadotropin-releasing hormone agonist(GnRH-a)therapy in patients with ovarian endometrioma after conservative surgery.Methods Using a retrospective cohort study analysis,206 patients who underwent conservative surgery for ovarian endometriosis cysts at the Department of Gynecology,Affiliated Hospital of Nanjing University of Chinese Medicine from December 2014 to December 2018 were selected and divided into 138 cases in the observation group(postoperative combined GnRH-a use for 6 months)and 68 cases in the control group(postoperative with no drug).Recurrence between two groups and the scores of dysmenorrhea,pain during in tercouse(PDI),and chronic pelvic pain were compared between two groups at different times in 2 years after surgery.Results In the 2 years follow-up,the observation group was superior with statistical significance in the comparison of chronic pelvic pain and dysmenorrhea scores between the two groups and time points(P<0.05).There was no significant difference in intergroup effect and time effect of sexual intercourse pain(P>0.05).The recurrence rate of patients in the observation group was lower than that of the control group in the first year after surgery(3.62%vs 11.77%,P<0.05),while no significant difference in recurrence rate of two groups was found in the second year after surgery(P>0.05),but the 2-year cumulative recurrence rate in the observation group was lower than that in the control group(13.24%vs 25.00%,P<0.05).Conclusion GnRH-a can be a choice for postoperative pain management and recurrence prevention in endometriosis.