腹腔镜手术联合药物治疗子宫内膜异位症的临床疗效评价

目的 探讨腹腔镜手术联合药物治疗子宫内膜异位症（EMs）的临床疗效.方法 选取2011年3月至2012年1月于江苏省常州市中医医院接受腹腔镜手术联合药物治疗的60例EMs患者为研究对象,按不同治疗方式,将其随机分为治疗组（n=30,腹腔镜手术＋注射用醋酸曲普瑞林＋口服去氧孕烯炔雌醇片）与对照组（n=30,腹腔镜手术＋注射用醋酸曲普瑞林）.2组患者在年龄、囊肿直径及部位、美国生育学会（AFS）分期等方面比较,差异无统计学意义（P〉0.05）（本研究遵循的程序符合江苏省常州市中医医院妇科人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象的知情同意,并与之签署临床研究知情同意书）.对比分析2组患者接受药物治疗后第1,3,6,12个月的疗效及不良反应.结果 2组患者的EMs症状缓解率（82.33% vs.86.01%）及复发率（36.67% vs.40.00%）比较,差异无统计学意义（χ2=0.48,P=0.22;χ2=0.07,P=0.20）,但实验组患者阴道出血、雌激素改变及更年期症状等不良反应发生率显著低于对照组,2组比较,差异有统计学意义（P〈0.05）.治疗后随访12个月显示,2组雌二醇[（41.0±23.4）pmol/L vs.（0.0±0.2） pmol/L]和CA125水平（28.0±9.5 vs.17.0±8.9）比较,差异有统计学意义（t=9.60,4.63;P〈0.05）.结论 腹腔镜手术＋注射用醋酸曲普瑞林＋口服去氧孕烯炔雌醇片治疗EMs不会增加EMs的复发率,且不良反应小,经济实惠,值得在临床上推广应用.

Clinical Analysis of Laparoscopic Operation Combined With Drugs Thearpy in the Treatment of Endometriosis

Objective To evaluate the effects of laparoscopic operation combined with drug therapy in the treatment of endometriosis （EMs）. Methods Clinical data of 60 patients who were diagnosed as EMs from March 2011 to January 2012 in Changzhou Traditional Chinese Medicine Hospital of Jiangsu Province were analyzed prospectively. All cases were divided randomly into the treatment group （n= 30, laparoscopic operation ＋triptorclin acetate for injection-desogestrel and ethinylestradiol tablets） and control group （n= 30, laparoscopic operation ＋triptorclin acetate for injection）. There had no significant differences between two groups on age, cyst diameter and location, American Fertility Society （AFS） staging and so on （P〈 0.05）. This study follows the application conforms to the ethics standards set by the human subjects committee of Changzhou Traditional Chinese Medicine Hospital, approved by the committee, grouped with the informed consent of the subjects, and signing the clinical research informed consent. The efficacy and adverse reactions were collected through follow-up by the end of 1, 3, 6, 12 months after therapy. Results There were no significant differences in symptom relief rates （82.33% vs. 86.01%） and recurrence rates （36.67% vs. 40.00%） （x^2 = 0.48, P = 0.22; Xz = 0.07, P= 0.20）. However in the treatment group, estradiol level, vaginal bleeding, menopausal symptoms and other adverse reactions were significantly lower than those in control group （P〈0.05）. By the end of 12 months after the treatment, the statistically significant difference were found in the aspects of estradiol I-（41.0＋ 23.4） pmol/L vs. （0. 04- 0.2） pmol/L] and CAI2s levels （28.05：9.5 vs. 17.0＋8.9）（t=9.60,4.63;P〈0.05）. Conclusions The treatment of laparoscopic operation combined with triptorelin acetate for injection and desogestrel and ethinylestradiol tablets does not increase the recurrence rate of EMs, and the adverse reactions of which is much less.