地诺孕素联合腹腔镜手术治疗子宫内膜异位症不孕的效果

Effect of dinorgestrel combined with laparoscopic surgery on infertility patients with endometriosis

目的分析地诺孕素(DNG)联合腹腔镜手术治疗子宫内膜异位症(EMT)不孕的临床效果。方法于2019年8月至2022年8月在郑州市妇幼保健院收集病例展开研究,将严格按照纳排标准筛选的118例EMT不孕患者作为研究对象,基于"简单随机化方法"分为DNG组与促性腺激素释放激素激动剂(GnRH-a)组,每组59例。GnRH-a组采用GnRH-a联合腹腔镜手术,DNG组采用DNG联合腹腔镜手术。对比两组临床效果、症状恢复情况、卵巢功能[窦状卵泡数(AFC)、抗缪勒管激素(AMH)、卵泡刺激素(FSH)]、血管生长因子[碱性成纤维生长因子(bFGF)、血小板衍生生长因子(PDGF)]水平及不良反应发生率、复发率、妊娠率。结果DNG组总有效率(98.31%,58/59)高于GnRH-a组(86.44%,51/59),P<0.05。DNG组排卵恢复时间、月经恢复时间短于GnRH-a组(P<0.05)。治疗后,DNG组AFC多于GnRH-a组,AMH水平高于GnRH-a组,FSH水平低于GnRH-a组(P<0.05)。治疗后,DNG组bFGF、PDGF水平低于GnRH-a组(P<0.05)。DNG组不良反应发生率(15.25%,9/59)低于GnRH-a组(32.20%,19/59),P<0.05。DNG组复发率、妊娠率(5.26%,3/57;64.91%,37/57)均低于GnRH-a组(16.36%,9/55;45.45%,25/55),P均<0.05。结论DNG联合腹腔镜手术治疗EMT不孕效果确切,可改善临床症状和卵巢功能,提高妊娠率,并能抑制血管生长因子表达,降低复发率,且安全性良好。

Objective To analyze the effect of dinorgestrel(DNG)combined with laparoscopic surgery on infertility patients with endometriosis(EMT).Methods The study was conducted on cases of illness collected from Zhengzhou Maternal and Child Health Hospital from August 2019 to August 2022.A total of 118 infertility patients with EMT who met exclusion criteria of the strict screening were selected as research objects,and they were divided into the DNG group and the GnRH-a group based on the simple randomized method,with 59 cases in each group.The GnRH-a group was treated with gonadotropin-releasing hormone agonist(GnRH-a)combined with laparoscopic surgery,and the DNG group was treated with DNG combined with laparoscopic surgery.The clinical effect,symptom recovery,ovarian function assessed by sinusoidal follicle number(AFC),anti-Mullerian hormone(AMH)and follicle-stimulating hormone(FSH),levels of vascular growth factors,including basic fibroblast growth factor(bFGF)and platelet-derived growth factor(PDGF),incidence of adverse reactions,recurrence rate and pregnancy rate were compared between the two groups.Results The total effective rate in the DNG group(98.31%,58/59)was higher than that in the GnRH-a group(86.44%,51/59),P<0.05.Ovulation recovery time and menstrual recovery time in the DNG group were shorter than those in the GnRH-a group(P<0.05).After treatment,the DNG group had more AFC,higher level of AMH,and lower level of FSH compared with the GnRH-a group(P<0.05).After treatment,the levels of bFGF and PDGF in the DNG group were lower than those in the GnRH-a group(P<0.05).The incidence of adverse reactions in the DNG group(15.25%,9/59)was lower than that in the GnRH-a group(32.20%,19/59),P<0.05.The recurrence rate in the DNG group(5.26%,3/57)was lower than that in the GnRH-a group(16.36%,9/55),while the pregnancy rate(64.91%,37/57)was lower than that in the GnRH-a group(45.45%,25/55),all P<0.05.Conclusions DNG combined with laparoscopic surgery in the treatment of EMT infertility is effective.It can improve clinical symptoms and ovarian function,increase the pregnancy rate,inhibit the expression of vascular growth factors,and reduce the recurrence rate,with good safety.