超声引导穿刺硬化术联合地诺孕素治疗卵巢子宫内膜异位囊肿的疗效

Effects of ultrasound-guided puncture sclerotherapy combined with dienogest in the treatment of ovarian endometriosis cyst

目的分析超声引导穿刺硬化术联合地诺孕素治疗卵巢子宫内膜异位囊肿(OEM)1年内的临床疗效,及该治疗方案对卵巢储备功能的影响。方法回顾性分析2019年6月至2020年12月于北京大学深圳医院超声介入中心及妇产中心行超声引导穿刺抽液硬化术后联合地诺孕素管理的20例未婚育龄期OEM患者,通过比较其治疗期间囊肿直径变化、抗苗勒氏管激素(AMH)、血清肿瘤标志物CA-125/CA-199以及视觉模拟评分(VAS)等参数变化,采用配对t检验及秩和检验分析该治疗方案对育龄期OEM的疗效及其对卵巢储备功能的影响,并记录服用地诺孕素过程中发生的不良反应。结果经超声穿刺抽液硬化术联合地诺孕素治疗后的OEM患者,其OEM直径、血清CA-125/CA-199浓度以及痛经VAS评分均呈下降趋势,且与治疗前比较差异均有统计学意义(P<0.01);而卵巢储备功能指标血清AMH水平不受治疗的影响,与治疗前水平比较差异无统计学意义(P>0.01)。此外,不规则阴道出血是地诺孕素长期管理期间最常见的并发症,少数可出现轻度体质量增加、脱发和痤疮等高雄激素等表现。随访过程中均未见药物对肝肾功能、凝血功能、乳腺等不良影响。结论超声引导穿刺抽液硬化术联合地诺孕素治疗OEM可有效缩小囊肿的直径,同时可明显改善患者痛经症状,降低血清CA-125/CA-199数值,对卵巢储备功能影响小。地诺孕素药物治疗不良反应小,可作为超声引导穿刺硬化术治疗OEM的长期管理药物。

Objective To analyze the one-year clinical efficacy of ultrasound-guided puncture sclerotherapy combined with dienogest in the treatment of ovarian endometriotic cyst(OEM)and to explore the impacts on the ovarian reserve function.Methods Clinical data of 20 unmarried OEM patients of childbearing age who underwent ultrasound-guided puncture sclerotherapy combined with dienogest during Jun.2019 and Dec.2020 were retrospectively analyzed.The changes in cyst diameter,anti Mullerian hormone(AMH),serum tumor markers CA-125/CA-199 and visual analog scale(VAS)were analyzed.The efficacy and effects on the ovarian reserve function were evaluated with paired t-tests and rank sum tests.Adverse reactions of dienogest were recorded.Results After treatment,the OEM diameter,serum CA-125/CA-199 concentrations and dysmenorrhea VAS score were significantly reduced(P<0.01),while serum AMH level remained unchanged(P>0.01).Irregular vaginal bleeding was the most common complication during long-term dienogest use.A few patients presented with mild weight gain,hair loss,and acnes.No adverse effects on liver and kidney function,coagulation function and mammary gland were observed during follow-up.Conclusion Ultrasound-guided puncture sclerotherapy combined with dienogest can effectively reduce the diameter of cysts in OEM patients,alleviate the menstrual pain and lower serum CA-125/CA-199 levels,with minimal impacts on ovarian reserve function.Dienogest has minimal adverse reactions and can be used for a long-term in the treatment of OEM.