重度子宫内膜异位症术后应用孕三烯酮(进口)和达那唑的疗效比较

目的 :探讨重度子宫内膜异位症术后应用孕三烯酮和达那唑后复发率及不良反应比较。方法 :患重度子宫内膜异位症术后 6 6例 ,36例服用孕三烯酮 (进口 ) 2 .5mg ,每周 2次 ,疗程为 3～ 6mo ;30例服达那唑 2 0 0mg ,bid或tid ,疗程为 3～ 6mo ,随访 1～ 2a ,观察临床症状、体征、不良反应及妊娠情况。结果 :2种药物术后控制症状有效率达 10 0% ,术后应用孕三烯酮复发率为 6 % ,妊娠率 6 4% ,而用达那唑复发率 16 % ,妊娠率 5 0 %。孕三烯酮的不良反应小。结论 :内膜异位症术后应用孕三烯酮和达那唑能有效地防止内膜异位症复发 ,提高妊娠率。但孕三烯酮不良反应小 ,使用方便     

小柴胡汤对子宫内膜异位症大鼠异位内膜形态结构的影响

目的:探讨小柴胡汤治疗大鼠子宫内膜异位症对其异位内膜形态结构的影响。方法:采用实验性大鼠子宫内膜异位症动物模型,分 5组,小柴胡汤组分别给小柴胡汤 5, 10, 15g·kg-1·d-1,达那唑组给达那唑0. 1g·kg-1,对照组给蒸馏水 20mL·kg-1,均ig,qd。从大体、光镜、电镜等形态学水平,观察小柴胡汤对子宫内膜异位症大鼠异位内膜形态结构的影响。结果:给予小柴胡汤 5, 10, 15g·kg-1·d-1 4wk后,子宫内膜异位症大鼠均可见异位内膜体积缩小、萎缩;在光镜和电镜下观察到子宫内膜异位症大鼠异位内膜生长明显受抑制。结论:小柴胡汤对实验性大鼠子宫内膜异位症具有治疗作用。     

达那唑栓治疗复发性子宫内膜异位症的临床分析

目的 观察达那唑栓治疗子宫内膜异位症的疗效及不良反应.方法 选择曾行开腹或腹腔镜手术确诊的子宫内膜异位症再次复发患者87例,随机单盲分为两组,其中达那唑栓组46例,第一个月每晚2粒,之后每晚1粒,阴道或肛门用药,疗程6个月.达那唑胶囊对照组41例,口服给药,2次/d,疗程6个月,定期随访.比较应用达那唑栓及达那唑胶囊治疗子宫内膜异位症的症状、体征变化及不良反应情况.结果 达那唑栓组痛经、非经期下腹痛、性交痛、后陷凹结节、肛门坠痛的改善率与达那唑胶囊组比较,差异均无统计学意义(P＞0.05).达那唑栓组体质量改变、转氨酶升高、阴道异常出血、闭经及痤疮不良反应发生率显著低于达那唑胶囊组,差异有统计学意义(P＜0.05).结论 达那唑栓治疗复发性子宫内膜异位症与达那唑胶囊疗效相当,但不良反应较达那唑胶囊明显减少,安全性高.     

腹腔镜术后联合内美通治疗子宫内膜异位症的临床疗效观察

目的观察腹腔镜术后加用内美通治疗子宫内膜异位症的临床疗效、不良反应及停药后对妊娠率、复发率的影响。方法77例经腹腔镜手术确诊为子宫内膜异位症的患者,随机分为2组:达那唑组39例,口服达那唑200mg,2次/d;内美通组38例,口服内美通2.5mg,2次/周,两组均连续用药3个月。观察并比较两组临床症状、体征、用药后的副作用及停药后1年内症状复发率和妊娠率等变化。结果两组症状、体征缓解率相似,均较治疗前明显改善(P<0.01);内美通组体重增加、痤疮、肝功能损害、潮热、阴道干燥和异常出血等不良反应发生率明显低于达那唑组(P<0.05)。停药后,内美通组排卵和月经平均恢复时间较达那唑组短(P<0.05);1年内达那唑组不育症患者的累积妊娠率为52.63%,内美通组为58.97%,两组比较差异无统计学意义(P>0.05);1年内达那唑组和内美通组症状和体征复发情况相似,两组比较差异无统计学意义(P>0.05)。结论腹腔镜手术后加用内美通可有效控制子宫内膜异位症患者症状,提高不孕患者的妊娠机会,且副作用小、服用方便,值得临床推广应用。     

孕三烯酮治疗子宫内膜异位症的观察分析

目的探讨孕三烯酮治疗子宫内膜异位症的疗效。方法将110例子宫内膜异位症患者随机分为观察组和对照组各55例。对照组给予醋酸甲孕酮40mg／d，观察组给予孕三烯酮2．5mg，每周两次，疗程共6个月。观察治疗前后症状、体征、病灶大小及副反应。结果观察组的总主观症状评分于治疗3个月下降75％，6个月下降89％。对照组的治疗3个月下降60％，6个月下降83％；观察组于治疗3个月及6个月时均有效于对照组（P〈0.05）。观察组治疗后其病灶缩小较对照组明显（P〈0．05）且不良反应小。结论孕三烯酮和醋酸甲孕酮均能治疗子宫内膜异位症，孕三烯酮疗效更好且不良反应小。     

达那唑栓治疗子宫内膜异位症的临床分析

目的 观察达那唑栓治疗子宫内膜异位症(EMT)的疗效及不良反应.方法 2003年1月-2006年5月应用达那唑栓治疗子宫内膜异位症患者64例:达那唑栓50mg,第一个月每晚2粒,之后每晚1粒,阴道或肛门用药,对照组40例口服达那唑胶囊:达那唑胶囊200mg,每8h 1次口服,3个月为1疗程.结果 采用达那唑栓治疗组64例,总有效率达93.8%,口服达那唑胶囊治疗组40例,总有效率达92.5%,2组比较无显著性差异(P>0.05).而栓剂组由于阴道或肛门用药的药量较小,仅为口服的1/12,未发现明显不良反应,不影响排卵,后者不良反应明显,造成闭经有显著差异(P<0.05).结论 达那唑栓治疗子宫内膜异位症安全、有效,值得推广应用.     

综合疗法治疗子宫内膜异位症痛经的临床研究

目的探讨长效醋酸甲孕酮(DMPA)联合调经益母片综合治疗子宫内膜异位症痛经的疗效。方法将在我院治疗的子宫内膜异位症患者57例,都在月经周期第l～5天臀部肌内注射DMPA150mg,以后每隔(90±7)d肌注一次,半年1个疗程,每个患者治疗l～2个疗程;同时在月经第5天口服调经益母片,2～4片每次,一天2次,每个月经周期口服20d。结果综合治疗前痛经发生率是91.2%治疗后痛经发生率降至7.0%,经统计学处理,结果有统计学意义(P<0.05)。结论 DMPA联合调经益母片综合治疗子宫内膜异位症痛经具有安全、临床效果明显、价格低廉、副反应小的特点,值得临床推广。     

醋酸甲羟孕酮治疗子宫内膜异位症的疗效分析

目的探讨醋酸甲羟孕酮（DMPA）治疗子宫内膜异位症的疗效。方法将110例子宫内膜异位症患者随机分为观察组和对照组各55例,观察组于月经来潮第1～5d肌注DMPA150mg,之后每30d重复1次,连续注射6次;对照组于月经第1天开始服用孕三烯酮,2次/周,2.5mg/次,连用6个月。对照组给予曲普瑞林3.75mg,肌肉注射1次,4周后给予该药物半量1.875mg肌注,每4周1次,共24周。结果用药后两组患者总主观症状评分明显下降,卵巢异位囊肿明显缩小,两组有效率均为100%,疗效差异无统计学意义,血清癌抗原125（CA125）及性激素水平明显下降,两组均无严重不良反应。结论醋酸甲羟孕酮（DMPA）治疗子宫内膜异位症疗效满意,且价格低,适合于长期治疗。     

戈舍瑞林联合腹腔镜治疗中重度子宫内膜异位症44例

目的 观察腹腔镜手术联合戈舍瑞林治疗中重度子宫内膜异位症的疗效.方法 选择经腹腔镜手术诊断并治疗的中重度子宫内膜异位症患者124例,术后随机分为3组.戈舍瑞林组44例,术后第3天开始皮下注射戈舍瑞林3.6 mg,此后每月1次,连用3～6个月;达那唑组加例,术后第3天开始口服达那唑0.2 g,2次/d,连用3～6个月;对照组40例未用药.所有患者均随访12个月并观察疗效.结果 戈舍瑞林组、达那唑组、对照组总有效率分别为86.36%,85.00%,55.00%,复发率分别为9.09%,15.00%,45.00%,术后1年妊娠率分别为36.36%,35.00%,5.00%.两用药组与未用药组比较,差异均有显著性(P＜0.05),但用药组之间比较差异无显著性(P＞0.05).戈舍瑞林组、达那唑组肝损害率分别为15.65%,50.00%,差异有显著性(P＜0.05).结论 腹腔镜联合药物治疗中重度子宫内膜异位症疗效确切,能降低复发率、提高妊娠率.且戈舍瑞林较达那唑不良反应小、使用方便.     

子宫内膜异位症腹腔镜术后联合应用亮丙瑞林、达那唑对比性临床研究

目的 研究子宫内膜异位症患者术后联合亮丙瑞林、达那唑治疗前后的血清CA125及骨密度的变化及疗效.方法 经腹腔镜手术确诊后随机分为亮丙瑞林组和达那唑组药物治疗,所有患者子治疗前后3个月测定血清CA125、骨密度（BMD）值及疼痛VRS评分.结果 亮丙瑞林治疗组患者CA125水平低于达那唑组,骨密度值、疼痛VRS评分明显高于达那唑组.结论 ①亮丙瑞林和达那唑均能有效治疗子宫内膜异位症,并控制其复发.②亮丙瑞林对患者骨密度的影响小于达那唑.     

The anti-inflammatory action of danazol and leuprorelin acetate depot on endometriosis is CRH independent

Corticotropin-releasing hormone (CRH) is a hypothalamic neuropeptide involved in the neuroendocrine response to stress, also playing a role in cell mediated immune functions. The aim of this study was to determine the circulating in the serum CRH levels in women with endometriosis and investigate the effect of the routinely 6-month administered treatment of danazol or leuprorelin acetate depot on these hormonal levels. Serum CRH levels were not significantly different in women with endometriosis and in the control group. The 6-month danazol or leuprorelin treatment had no effect on the levels of CRH. Three months after danazol treatment CRH levels were significantly lower (p < 0.005) than those before treatment. In contrast, after treatment with leuprorelin, CRH levels were significantly higher (p < 0.001). Our results suggest that endometriosis is not associated with CRH and that danazol as well as leuprorelin acetate depot have no effect on these levels during the treatment-specific period. However, they both showed significant fluctuations after the administration of these compounds ceased.     

Current understanding on pharmacokinetics,clinical efficacy and safety of progestins for treating pain associated to endometriosis

Introduction: Endometriosis is a chronic estrogen and progestogen responsive inflammatory disease associated with pain symptoms and infertility. The medical therapy of endometriosis aims to induce decidualization within the hormonally dependent ectopic endometrium, and it is often administered to ameliorate women’ pain symptoms or to prevent post-surgical disease recurrence. A variety of progestins have been used in monotherapy for the medical management of women with endometriosis.

Areas covered: This review aims to offer the reader a complete overview of pharmacokinetic (PK) and clinical efficacy of progestins for the treatment of endometriosis.

Expert opinion: Each progestin has a distinct PK parameters and pharmacodynamics affinity not only for progesterone receptor, but also for other steroid receptors, such as estrogen, androgen, and glucocorticoid. Moreover, progestins can also be delivered in different formulations. All these characteristics influence their final biological effect. Randomized, controlled, non-blinded studies support the use of oral progestin-only treatment for pelvic pain associated with endometriosis. Currently, the only two progestins approved by Food and Drug Administration (FDA) for the treatment of endometriosis are norethindrone acetate (NETA) and depot medroxyprogesterone acetate (DMPA).     

Endometriosis 1990. Current treatment approaches

Endometriosis is an extremely common gynaecological disease, affecting between 1 and 5% of women of reproductive age. Women with endometriosis typically present for medical care with one of more of the following problems: pelvic pain, infertility, or a large adnexal mass (an endometrioma). The primary treatment for an endometrioma is surgical. However, long term postoperative hormone therapy may be necessary to prevent new endometriomas from developing. There is no evidence that hormonal therapy of endometriosis will improve fecundability in women with endometriosis and infertility. Pelvic pain due to endometriosis can be successfully treated with hormonal agents in the majority of patients. Four basic hormonal regimens are currently available for the treatment of endometriosis: (a) danazol; (b) gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); gonadorelin] agonists; (c) progesterones (progestins); and (d) combined estrogens and progesterones. Randomised, controlled, clinical trials suggest that danazol and the GnRH agonists are equally effective in the treatment of endometriosis. However, the side effects caused by danazol and the GnRH agonists are markedly different. Danazol produces androgenic side effects including weight gain, hirsutism, acne, oily skin and deepening of the voice. GnRH agonists produce side effects due to hypoestrogenism, including hot flushes, osteoporosis and dry vagina. The ideal drug regimen for the treatment of endometriosis remains to be developed.     

子宫内膜不典型增生的药物转化治疗

目的 探讨醋酸甲羟孕酮治疗子宫内膜不典型增生的效果.方法 选择本院2012年5月～2013年8月收治的子宫内膜不典型增生患者56例,随机分为研究组和对照组,每组各28例,研究组患者给予醋酸甲羟孕酮治疗,2 mg/d,2次/d;对照组患者口服戊酸雌二醇片,1 mg/d;两组患者均治疗3个月,观察两组患者的治疗效果,采用PBAC评分观察治疗前后月经或阴道出血情况.结果 治疗后研究组总有效率明显低于对照组,两组差异有统计学意义.治疗后研究组阴道出血情况明显改善,PBAC评分明显高于对照组,两组差异有统计学意义.结论 醋酸甲羟孕酮治疗子宫内膜不典型增生疗效显著,可有效改善患者的出血症状,费用较低,适合患者长期治疗.     

腹腔镜手术联合复方醋酸棉酚片治疗中重度子宫内膜异位症的临床疗效观察

目的 观察复方醋酸棉酚片辅助腹腔镜手术治疗子宫内膜异位症的临床疗效.方法 选择经腹腔镜治疗并确诊为子宫内膜异位症的患者93例,按术后用药情况随机分为A、B两组,A组48例患者于术后应用复方醋酸棉酚片6个月,B组45例患者于术后应用达菲林6个月.比较两组的疼痛缓解率、复发率及药物不良反应发生率.结果 A、B两组疼痛缓解率分别为93.75%,95.56%,复发率分别为6.25%,4.44%,不良反应发生率分别为4.17%,13.33%,两组比较差异无统计学意义.结论 复方醋酸棉酚片辅助腹腔镜治疗子宫内膜异位症安全有效,复发率低,不良反应少,且费用低廉,值得在临床推广使用.     

曲普瑞林在子宫内膜异位症术后的临床应用

目的：探讨促性腺激素释放激素激动药曲普瑞林用于子宫内膜异位症保守性手术后辅助治疗的疗效和安全性。方法：回顾分析37例子宫内膜异位症患者保守性手术后的随访资料，比较应用曲普瑞林与未用药组的复发率。观察药物不良反应。结果：观察组复发率5．5％，明显低于对照组复发率(36．8％)，P＜0．05。曲普瑞林不良反应主要为低雌激素引起的绝经期症状，停药后不良反应消失，不影响疗程，停药后4～9周月经恢复。结论：曲普瑞林用于子宫内膜异位症的术后辅助治疗是有效和安全的。     

Serum concentrations of growth factors in women with and without endometriosis: the action of anti-endometriosis medicines

Endometriosis is a common gynecologic syndrome of unknown etiology and pathogenesis. Growth factors and inflammatory mediators produced by peritoneal leukocytes have recently been postulated to participate in the pathogenesis of endometriosis. Angiogenic factors released from peritoneal macrophages may also play a role in the development of this disease. In the present study, we investigate the soluble levels of vascular endothelial growth factor (VEGF), epidermal growth factor-receptor (EGF-R), granulocyte/macrophage-colony stimulating factor (GM-CSF), Insulin-like growth factor-1 (IGF-1) and interferon-gamma (IFN-gamma) in the serum of 28 women with and 20 without endometriosis. We also compared these levels before, during and after treatment with danazol and leuprorelin acetate depot, the two therapeutic regiments of choice concerning this disease. We found that only sVEGF levels were higher in women with endometriosis in comparison to controls (P < 0.001) while sEGF-R is not present. GM-CSF, IGF-1 and IFN-gamma soluble levels are not affected in either healthy or endometriotic subjects. The 6-month treatment with danazol decreased sVEGF levels (P < 0.02) and increased sEGF-R levels (P < 0.001). These observations support the view that VEGF may be associated with the disease process and that danazol may bring sVEGF levels to a normal threshold. However, future studies will be focused on the anti-angiogenic control of the action of VEGF in patients with endometriosis.     

腹腔镜联合药物治疗中重度子宫内膜异位症的临床观察

目的探讨腹腔镜联合药物治疗中重度子宫内膜异位症的临床价值。方法选择经腹腔镜手术诊断并治疗的中重度子宫内膜异位症患者62例,术后随机分为3组,孕三烯酮组(22例):术后第3天开始服孕三烯酮2.5mg,每周2次;达那唑组(20例):术后第3天开始服达那唑0.2g,2次/d,两药均连用3～6个月;未用药组(20例)。所有患者随访12个月,观察疗效。结果孕三烯酮组、达那唑组、未用药组有效率分别为86.36%、85.0%、55.0%;复发率分别为9.09%、15.0%、45.0%;妊娠率分别为36.36%、35.0%、5%。两用药组与未用药组比较差异均有显著意义(P<0.05),但用药组之间比较差异无显著意义(P>0.05)。孕三烯酮组、达那唑组肝损率分别为13.63%、50.0%;体质理增加率分别为9.09%、40.0%,差异有显著意义(P<0.05)。结论腹腔镜联合药物治疗中重度内异症疗效确切,能降低复发率,提高妊娠率。且孕三烯酮较达那唑不良反应小,使用方便。     

子宫内膜异位症术后小剂量米非司酮辅助治疗的疗效分析

目的:探讨子宫内膜异位症(内异症)手术后服用小剂量米非司酮治疗的临床疗效。方法:米非司酮组(M组)37例,米非司酮10 mg口服,每日1次;达那唑组(D组)35例,达那唑200 mg口服,每日2~3次。均连续用药3个月,观察两组症状、体征改善情况,用药后的不良反应及用药3个月时性激素水平生化指标的变化。结果:两组症状、体征缓解率相似。M组不良反应发生率显著低于D组(P<0.05)。M组雌二醇(E2)为(204.9±45.3)pmol/L,保持在卵泡期水平,D组为(94.3±33.0)pmol/L,为绝经后水平,两组比较,差异有极显著性(P<0.01)。停药13~15天,M组E2水平为(1221.6±384.2)pmol/L,较用药前(排卵期)下降,但差异无显著性(P>0.05),D组为(815.1±376.0)pmol/L,较用药前(排卵期)明显下降(P<0.05)。M组停药后基础体温上升和月经复潮时间较D组为短。结论:内异症手术后加用米非司酮可明显改善患者症状和体征,疗效与达那唑类似,但不良反应明显减少。米非司酮10 mg/d,3个月治疗可使血清E2保持在卵泡期水平。