米非司酮片联合超脉冲CO_(2)激光治疗腹腔镜术后子宫内膜异位症 不孕患者的疗效及对性激素、子宫内膜容受性、炎症因子的影响

Efficacy of mifepristone tablets combined with ultra-pulsed CO_(2) laser in the treatment of infertility patients with endometriosis after laparoscopic surgery and their effects on sex hormones,endometrial receptivity,and inflammatory factors

目的分析米非司酮片联合超脉冲CO_(2)激光治疗腹腔镜术后子宫内膜异位症不孕患者的临床疗效及对性激素、子宫内膜容受性、炎症因子的影响。方法前瞻性选取2020年12月至2021年12月唐山市妇幼保健院南湖院区收治的80例子宫内膜异位症不孕患者,所有入组的患者均进行腹腔镜手术治疗。按照随机数字表法将其分为观察组和对照组,每组各40例。在术后首个月经周期的第3天,对照组患者给予地诺孕素片干预治疗,观察组患者给予米非司酮片联合超脉冲CO_(2)激光干预治疗,两组均随访12个月。观察并记录两组患者临床疗效、性激素[卵泡刺激素(FSH)、促黄体素(LH)和雌二醇]、子宫内膜容受性、血清炎症因子[白细胞介素(IL)-1β、IL-6及肿瘤坏死因子α(TNF-α)]水平及妊娠情况。结果观察组总有效率为97.50%,显著高于对照组(80.00%),差异有统计学意义(P<0.05)。治疗3个月后,观察组患者FSH、LH和雌二醇水平分别为(7.27±2.63)IU/L、(6.35±1.89)U/L、(117.17±21.51)pmol/L,均显著高于对照组[(5.24±1.78)IU/L、(3.87±1.58)U/L、(66.21±11.72)pmol/L],差异均有统计学意义(P<0.05)。治疗3个月后,观察组的子宫内膜厚度与A型和B型子宫内膜占比分别为(9.56±0.48)mm、92.50%,均高于对照组[(9.05±0.54)mm、62.50%],差异均有统计意义(P<0.05)。观察组治疗3个月后的IL-1β、IL-6、TNF-α水平分别为(12.16±1.16)mg/L、(26.25±3.63)mg/L、(19.23±1.19)g/L,均显著低于对照组[(14.12±2.27)mg/L、(30.25±3.15)mg/L、(22.26±2.42)g/L],差异均有统计学意义(P<0.05)。随访12个月,观察组的自然妊娠率、自然分娩率分别为67.50%、35.00%,均高于对照组(45.00%、17.50%),差异均有统计学意义(P<0.05)。结论米非司酮片联合超脉冲CO_(2)激光干预治疗可以提高腹腔镜手术治疗子宫内膜异位症合并不孕的临床疗效,调节机体炎症因子水平与体内激素水平,同时有效改善妊娠情况及子宫内膜容受性。

Objective To analyze the clinical efficacy of mifepristone tablets combined with ultra-pulsed CO_(2) laser in the treatment of infertility patients with endometriosis after laparoscopic surgery,as well as their effects on sex hormones,endometrial receptivity,inflammatory factors.Methods A total of 80 infertile patients with endometriosis admitted to Tangshan Maternal and Child Health Care Hospital(Nanhu District)from December 2020 to December 2021 were prospectively selected,and all enrolled patients underwent laparoscopic surgery.They were divided into the observation group and the control group by random number table method,with 40 cases in each group.On the 3rd day of the first postoperative menstrual cycle,the control group were given dinorgestrel tablets for intervention,and the observation group were given mifepristone tablets combined with ultra-pulse CO_(2) laser dry treatment.Both groups were followed up for 12 months.The clinical efficacy,sex hormones[follicle stimulating hormone(FSH),luteinizing hormone(LH),and estradiol],endometrial receptivity,serum inflammatory factors[interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)]levels,and pregnancy status were observed and recorded in two groups of patients.Results The total effective rate of the observation group was 97.50%,which was higher than that of the control group(80.00%),and the difference was statistically significant(P<0.05).After treatment,the levels of FSH,LH,and estradiol in the observation group were(7.27±2.63)IU/L,(6.35±1.89)U/L,and(117.17±21.51)pmol/L,respectively,which were significantly higher than those in the control group[(5.24±1.78)IU/L,(3.87±1.58)U/L,and(66.21±11.72)pmol/L],and the differences were statistically significant(P<0.05).After 3 months of treatment,the thickness of the endometrium and the proportion of type A and type B endometrium in the observation group were(9.56±0.48)mm and 92.50%,respectively,which were higher than those in the control group[(9.05±0.54)mm and 62.50%],and the differences were statistically significant(P<0.05).After 3 months of treatment,the levels of IL-1β,IL-6,TNF-αin the observation group were(12.16±1.16)mg/L,(26.25±3.63)mg/L,and(19.23±1.19)g/L,respectively,which were significantly lower than those in the control group[(14.12±2.27)mg/L,(30.25±3.15)mg/L,and(22.26±2.42)g/L],and the differences were statistically significant(P<0.05).After 12 months of follow-up,the natural pregnancy rate and natural delivery rate of the observation group were 67.50%and 35.00%,respectively,which were higher than those of the control group(45.00%and 17.50%),and the differences were statistically significant(P<0.05).Conclusion The combination of mifepristone tablets and superpulsed CO_(2) laser intervention therapy can improve the clinical efficacy of laparoscopic surgery for treating endometriosis with infertility,regulate the levels of fireworks stress indicators and hormones in the body,and effectively improve pregnancy and endometrial receptivity.