GnRH-a、LNG-IUS、地诺孕素在子宫内膜异位症腹腔镜保守手术患者中的应用价值

Application Value of GnRH-a,LNG-IUS and Dienogest in Patients with Endometriosis Undergoing Laparoscopic Conservative Surgery

目的:比较促性腺激素释放激素激动剂(GnRH-a)、左炔诺孕酮宫内缓释系统(LNG-IUS)、地诺孕素在子宫内膜异位症(EMS)腹腔镜保守手术患者中的应用价值。方法:选取2020年1月—2022年12月晋江市中医院收治的80例EMS腹腔镜保守手术患者。根据随机数表法将其分为GnRH-a组(26例)和LNG-IUS组(27例)和地诺孕素组(27例)。GnRH-a组给予注射用醋酸曲普瑞林治疗,LNG-IUS组给予LNG-IUS治疗,地诺孕素组给予地诺孕素片。比较三组治疗前、治疗6个月后疼痛程度、相关指标,不良反应、复发率。结果:治疗6个月后,地诺孕素组视觉模拟评分法(VAS)评分低于GnRH-a组、IUS-LNG组,差异有统计学意义(P<0.05)。治疗前,治疗6个月后,三组糖类抗原125(CA125)、雌二醇水平比较,差异无统计学意义(P>0.05)。地诺孕素组不良反应总发生率明显低于GnRH-a组,差异有统计学意义(P<0.05)。三组复发率比较,差异有统计学意义(P<0.05)。地诺孕素组复发率明显低于GnRH-a组,差异有统计学意义(P<0.05)。结论:GnRH-a、IUS-LNG、地诺孕素在EMS患者腹腔镜保守术后维持治疗中均可缓解患者疼痛,降低CA125、雌二醇水平,其中使用地诺孕素EMS术后复发率低,且安全性高。

Objective:To compare the application value of gonadotropin releasing hormone agonist(GnRH-a),levonorgestrel intrauterine extended release system(LNG-IUS)and Dienogest in patients with endometriosis(EMS)undergoing laparoscopic conservative surgery.Method:A total of 80 patients with EMS laparoscopic conservative surgery admitted to Jinjiang Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were selected.According to random number table method,they were divided into GnRH-a group(26 cases),LNG-IUS group(27 cases)and Dienogest group(27 cases).The GnRH-a group was given Triptorelin Acetate Microspheres for Injection,the LNG-IUS group was given LNG-IUS treatment,and the Dienogest group was given Dienogest Tablets.The pain degree,related indexes before treatment and after 6 months of treatment,adverse reactions and recurrence rate were compared among three groups.Result:After 6 months of treatment,the visual analogue scale(VAS)score of Dienogest group was lower than that of GnRH-a group and IUS-LNG group,and the differences were statistically significant(P<0.05).Before and after 6 months of treatment,there were no significant differences in carbohydrate antigen 125(CA125)and estradiol levels among the three groups(P>0.05).The total incidence of adverse reactions in Dienogest group was significantly lower than that in GnRH-a group,and the difference was statistically significant(P<0.05).There was significant difference in recurrence rate among the three groups(P<0.05).The recurrence rate of Dienogest group was significantly lower than that in GnRH-a group,and the difference was statistically significant(P<0.05).Conclusion:GnRH-a,LNG-IUS,and Dienogest all can alleviate pain and reduce the levels of CA125 and estradiol in maintenance treatment of patients with EMS after laparoscopic conservative surgery.The recurrence rate in EMS with Dienogest is low and the safety is high.