子宫内膜异位症腹腔镜手术后应用GnRH-a治疗对患者自然妊娠结局的影响

Effect of GnRH-a Treatment on Natural Pregnancy after Laparoscopic Endometriosis

【目的】探讨子宫内膜异位症腹腔镜手术后应用促性腺激素释放激素激动剂(GnRH-a)治疗对患者自然妊娠结局的影响。【方法】选取2016年10月至2019年10月在本院诊治的220例子宫内膜异位症患者,按照随机数字表法分为对照组和观察组,每组110例,两组均采用腹腔镜手术治疗,观察组术后采用GnRH-a治疗。两组术后均随访36个月,比较两组患者术后不同时间的卵巢储备功能指标[窦卵泡数目、卵巢体积及抗苗勒管激素(AMH)水平]、自然妊娠率、妊娠结局。【结果】观察组患者术后3个月、术后6个月的窦卵泡数目显著高于对照组同期(P<0.05),但两组患者卵巢体积比较,差异无统计学意义(P>0.05);观察组患者术后发生潮热13例、骨矿物质丢失17例,不良反应发生率为27.27%。观察组患者术后24个月、36个月自然妊娠率显著高于对照组同期(P<0.05);观察组患者术后36个月妊娠分娩率、足月分娩率均显著高于对照组(P<0.05);但两组胚胎停育率比较,差异无统计学意义(P>0.05);观察组早产率显著低于对照组(P<0.05);观察组患者术后24个月、36个月AMH水平显著高于对照组(P<0.05)。【结论】GnRH-a治疗腹腔镜子宫内膜异位症手术后患者,可促进患者卵巢储备功能恢复,提高自然妊娠率,且可降低胎儿早产风险。

【Objective】To observe the effect of gonadotropin releasing hormone agonist(GnRH-a)on natural pregnancy after laparoscopic endometriosis.【Methods】A total of 220 endometriosis patients diagnosed and treated in our hospital from October 2016 to October 2019 were selected and divided into the control group and the observation group according to the random number table method,with 110 cases in each group.Both groups were treated with laparoscopic surgery,while patients in the observation group received GnRH-a after laparoscopic endometriois.The patients were followed up for 36 months to compare the ovarian reserve function[the number of antral follicles,ovarian volume,and anti-Mullerian hormone(AMH)level],the number of natural pregnancy cases,postoperative natural pregnancy rate,and pregnancy outcome between the two groups of patients.【Results】The number of antral follicles in the observation group at 3 months and 6 months after the operation was significantly higher than that in the control group at the same period(P<0.05).There was no significant difference in ovarian volume between the two groups(P>0.05).There were 13 cases of hot flashes and 17 cases of bone mineral loss after operation in the observation group,the incidence of adverse reactions was 27.27%.The rate of natural pregnancy in the observation group at 24 months and 36 months was significantly higher than that in the control group(P<0.05).The pregnancy delivery rate,and the full-term delivery rate in the observation group were significantly higher than those in the control group 36 months after operation(P<0.05).However,the embryo developing arrest rateshowed no significant difference during 36-month follow-up between the two groups(P>0.05).The rate of premature delivery in the observation group was lower than that in the control group(P<0.05).The AMH level in the observation group was significantly higher than that in the control group at 24 months and 36 months after operation(P>0.05).【Conclusion】Application of GnRH-a treatment in patients after laparoscopic endometriosis can promote the recovery of ovarian reserve function,increase the rate of natural pregnancy,and reduce the risk of fetal premature delivery.