子宫内膜异位症术后不同药物治疗对腹腔内环境及妊娠率的影响

目的探讨子宫内膜异位症(endometriosis,EMs)腹腔镜手术后不同药物治疗对腹腔内环境及临床妊娠率的影响。方法 80例有生育要求的EMs患者经腹腔镜手术后,分别给予米非司酮和达菲林治疗,疗程3个月。术中、术后抽取腹腔内积液,进行如下检测:①激素测定,包括雌二醇(estradiol,E2)、孕酮(progesterone,P)、睾酮(testosterone,T)、促卵泡成熟素(follicle-stimulating hormone,FSH)和促黄体生成素(luteotrophic hormone,LH);②炎症因子主要包括白细胞介素家族(interleukin,IL),IL-1、IL-6、IL-8、IL-16,肿瘤坏死因子α(tumor necrosis factorα,TNF-α)和C反应蛋白(C reactive protein,CRP)。观察手术前后改变情况,评价妊娠率和安全性。结果所有患者均获得了12~16个月的随访,米非司酮组和达菲林组妊娠率分别为32.5%和45%,差异具有统计学意义(P0.05)。两组治疗后E2、P、T、FSH和LH均有下降,其中米非司酮组治疗前后激素水平比较除T外其他差异均具有统计学意义(P0.05),达菲林组治疗前后各激素指标比较差异均具有统计学意义(P0.05),治疗后两组比较差异均具有统计学意义(P0.05)。两组治疗后IL-1、IL-6、IL-8、TNF-α和CRP浓度均明显降低,IL-16浓度明显升高,与治疗前比较差异均具有统计学意义(P0.05),治疗后两组比较差异均具有统计学意义(P0.05)。两组不良反应发生率分别为25%和30%,差异无统计学意义(P0.05)。结论 EMs患者腹腔镜术后采用GnRH-a治疗能更有效地改善腹腔内环境,提高妊娠率。

Effect on Abdominal Environment and Pregnancy Rate of Different Drugs Using in the Treatment of Endometriosis after Laparoscopic Procedure

Objective To explore the effect on abdominal environment and pregnancy rate of different drugs using in the treatment of endometriosis （EMs） after laparoscopic procedure. Methods 80 cases with EMs who wanted conception underwent laparoscopic procedure were recruited, and they were treated with Mife- pristone or Diphereline by randomization for three months. The levels of estradiol （E2）, progesterone （P）, tes- tosterone （T）, FSH, LH, IL-1, IL-6, IL-8, IL-16, TNF-α and CRP were measured. And the pregnancy rate and safety were evaluated. Results All cases were followed up for 12 to 16 months, and the pregnancy rates were 32.5% and 45% （P 〈0.05） in the Mifepristone and Diphereline group, respectively. All the levels of hor- mones in the both two groups dropped except T level in Mifepristone group （P 〈 0. 05 ）, and the Diphereline group showed a bigger change. Also the concentration of IL-1, IL-6, IL-8, TNF-α and CRP all decreased in both groups （P 〈 O. 05 ）, but the Diphereline group changed more （ P 〈 O. 05 ）. The incidence of adverse reaction were 25% and 30% （P 〉 0. 05）, respectively. Conclusion The use of GnRH-a in the treatment of EMs after laparo- seopic procedure is an effective therapy to improve the abdominal environment and pregnancy rate.