子宫内膜异位症合并子宫内膜息肉术后长期管理效果分析

目的比较子宫内膜异位症(EM)合并子宫内膜息肉(EP)术后单独使用促性腺激素释放激素激动剂(GnRH-a)和GnRH-a联合左炔诺孕酮宫内节育系统(LNG-IUS)的疗效。方法选择2018年1月1日至2020年1月1日在安徽医科大学第一附属医院妇产科因EM合并EP接受宫腹腔镜联合保守性手术治疗的60例患者,按照随机数字表法分为观察组和对照组各30例,对照组术后单独予GnRH-a治疗,观察组予GnRH-a联合LNG-IUS治疗,随访1年,观察两组患者的痛经缓解情况、月经量及子宫内膜厚度变化情况、EM及EP复发情况。结果①两组均有一定的治疗效果,术后12个月两组的痛经程度、月经量及子宫内膜厚度较术前均下降(P<0.01);②术后12个月观察组痛经视觉模拟评分法评分(1.97±1.03)分]低于对照组(3.07±1.01)分],差异有统计学意义(P<0.01);③术后12个月观察组的月经量(36.00±9.39)分]少于对照组(82.07±10.82)分],差异有统计学意义(P<0.01);④术后12个月观察组的子宫内膜厚度(2.69±1.21)mm]薄于对照组(7.28±1.55)mm],差异有统计学意义(P<0.01)。⑤两组术后1年随访,观察组EM和EP复发率均低于对照组(3.33%比16.67%;0.00%比6.67%),但差异无统计学意义(P>0.05),观察组痛经症状复发率(0.00%比25.00%)及总复发率(3.33%比36.67%)低于对照组,差异有统计学意义(P<0.05,P<0.01)。结论GnRH-a联合LNG-IUS治疗EM合并EP疗效明确,可有效缓解痛经程度,减少患者的月经量,降低复发率,优于单用GnRH-a治疗。

Long-term management efficacy analysis of endometriosis complicated with endometrial polyps after operation

Objective To observe and compare the efficacy of gonadotropin-releasing hormone agonist(GnRH-a)alone and GnRH-a combined with levonorgestrel-releasing intrauterine system(LNG-IUS)after hysteroscopic and laparoscopic surgery in patients with endometriosis complicated with endometrial polyps.Methods From January 1,2018 to January 1,2020,60 patients with endometriosis complicated with endometrial polyps who were treated by hysteroscopic and laparoscopic conservative surgery in the Obstetrics and Gynecology Department of the First Affiliated Hospital of Anhui Medical University were randomly divided into observation group and control group,with 30 cases in each group.The control group was treated with GnRH-a alone after operation,while the observation group was treated with GnRH-a combined with LNG-IUS,follow-up for one year,observed the relief of dysmenorrhea,changes of menstrual flow and endometrial thickness,recurrence of endometriosis and endometrial polyps in both groups.Results①Both groups had a certain therapeutic effect,and the degree of dysmenorrhea,menstrual flow and endometrial thickness in both groups have decreased after 12 months(P<0.01).②Twelve months after operation,the VAS score of dysmenorrhea in observation group was lower than that in control group(1.97±1.03)points vs.(3.07±1.01)points],and the difference was statistically significant(P<0.01).③Twelve months after operation,the menstrual flow in the observation group was less than that in the control group(36.00±9.39)points vs.(82.07±10.82)points],with statistical significance(P<0.01).④Twelve months after operation,the endometrial thickness of the observation group was thinner than that of the control group(2.69±1.21)mm vs.(7.28±1.55)mm],with statistical significance(P<0.01).⑤After 1 year of follow-up,the recurrence rates of endometriosis and endometrial polyps in observation group were lower than that in control group(3.33%vs.16.67%;0.00%vs.6.67%),but there was no significant difference(P>0.05).The recurrence rate of dysmenorrhea symptoms and the total recurrence rate in the observation group were significantly lower than those in the control group(0.00%vs.25.00%,3.33%vs.36.67%),with statistical significance(P<0.05,P<0.01).Conclusions GnRH-a combined with LNG-IUS is effective in the treatment of endometriosis complicated with endometrial polyps,which can effectively relieve the degree of dysmenorrhea,reduce the menstrual flow and the recurrence rate,which is superior to GnRH-a alone.