戈舍瑞林缓释植入剂辅助腹腔镜手术治疗重度子宫内膜异位症伴发不孕症患者的疗效

Efficacy of goserelin sustained-release implant assisted laparoscopic surgery in the treatment of severe endometriosis with infertility

目的:探究戈舍瑞林缓释植入剂辅助腹腔镜手术治疗重度子宫内膜异位症(Endometriosis,EMT)伴发不孕症的疗效。方法:选取2020年2月~2021年3月我院收治的108例重度EMT伴发不孕症患者作为研究对象。根据腹腔镜术后采取的药物治疗方案不同,将所有患者分为戈舍瑞林联合孕三烯酮组和孕三烯酮组,各54例。两组均接受腹腔镜手术,术后孕三烯酮组接受孕三烯酮辅助治疗,戈舍瑞林联合孕三烯酮组在孕三烯酮组基础上,采用戈舍瑞林缓释植入剂联合辅助治疗。对比两组总有效率、治疗前后性激素水平、炎性因子水平、血管内皮功能、不良反应发生率和妊娠情况。结果:治疗3 m后,戈舍瑞林联合孕三烯酮组总有效率明显高于孕三烯酮组(P<0.05)。治疗3 m,戈舍瑞林联合孕三烯酮组血清雌二醇(Estradiol,E2)、卵泡刺激素(Follicle-stimulating hormone,FSH)、黄体生成激素(Luteinizing hormone,LH)、白细胞介素6(Interleukin,IL-6)、白细胞介素-8(Interleukin,IL-8)、C反应蛋白(C-reactive protein,CRP)、血清血管内皮生长因子(Vascular endothelial growth factor,VEGF)、血管生成素受体(Tyrosine kinase with immunoglobulin and epidermal growth factor homology domains,Tie)、血管生成素(Angiopoietin,Ang)水平均低于孕三烯酮组(P<0.05)。治疗期间,两组不良反应总发生率无明显差异(P>0.05);治疗后随访1 y,戈舍瑞林联合孕三烯酮组的妊娠率明显高于孕三烯酮组(P<0.05)。结论:与单用孕三烯酮辅助治疗相比,戈舍瑞林缓释植入剂联合辅助腹腔镜手术对重度EMT伴发不孕症患者的疗效更好,能更好地调节性激素水平和血管内皮功能相关指标,减轻机体的炎性反应,能显著提升患者治疗后1 y的妊娠率,安全性较高。

Objective:To investigate the efficacy of goserelin sustained-release implant assisted laparoscopic surgery in the treatment of infertility associated with severe endometriosis(EMT).Methods:One hundred and eight patients with severe EMT associated infertility admitted to our hospital from February 2020 to March 2021 were selected as the study subjects.According to the different drug treatment plans taken after laparoscopic surgery,all the patients were divided into two groups:goserellin plus gestrinone group and gestrinone group,54 cases in each group.Both groups received laparoscopic surgery.Gestrinone group received adjuvant treatment of gestrinone after surgery,and goserelin plus gestrinone group received adjuvant treatment of goserelin based on gestrinone group.The total effective rate,sex hormone levels,inflammatory factor levels,vascular endothelial function before and after treatment,adverse reaction rate and pregnancy were compared between goserellin plus gestrinone group and gestrinone group.Results:After 3 months of treatment,the total effective rate of goserellin plus gestrinone group was significantly higher than that of gestrinone group(P<0.05).After 3 months of treatment,the serum levels of estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),interleukin-6(IL-6),interleukin-8(IL-8),C-reactive protein(CRP),vascular endothelial growth factor(VEGF),angiopoietin receptor(Tie),and angiopoietin(Ang)in goserellin plus gestrinone group were lower than those of gestrinone group(P<0.05).During the treatment,the total incidence of adverse reactions had no significant difference between the two groups(P>0.05);follow up for 1 year after treatment,the pregnancy rate in the group of goserellin plus gestrinone was significantly higher than that in the gestrinone group(P<0.05).Conclusion:Compared with the adjuvant treatment of gestrinone alone,the combination of goserelin sustained-release implant and assisted laparoscopic surgery has a better effect on severe EMT patients with infertility,can better regulate the level of sex hormones and vascular endothelial function related indicators,reduce the inflammatory reaction of the body,can significantly increase the pregnancy rate of patients after treatment for one year,and has a higher safety.