腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症的疗效分析

目的：探讨腹腔镜手术联合促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist,GnRHa）治疗子宫内膜异位症的疗效.方法：回顾分析2007年9月-2010年12月经腹腔镜检查诊断为子宫内膜异位症98例患者的临床资料,根据患者的治疗意愿分为GnRHa组（n=64）和对照组（n=34）.GnRHa组于腹腔镜术后第5天开始肌内注射GnRHa,每次3.75 mg,每28天1次,共3次;进一步将GnRHa组分为醋酸曲普瑞林亚组（单纯用醋酸曲普瑞林,n=33）扣反添加亚组（应用醋酸曲普瑞林1个月后同时应用结合雌激素0.3 mg联合安宫黄体酮2.0mg反添加治疗,n=31）.对照组术后不采用任何药物治疗.98例患者术后随访12个月,比较各组患者的术后治愈率、缓解率、无效或复发率,以及GnRHa组两亚组间不良反应发生情况.结果：腹腔镜手术联合GnRHa治疗子宫内膜异位症可有效缓解疼痛,防止子宫内膜异位症复发.醋酸曲普瑞林亚组和反添加亚组的治愈率、缓解率、无效或复发率分别为57.6％、36.3％、6.1％和58.1％、32.2％、9.7％,两亚组比较差异无统计学意义（P＞0.05）;但两亚组的治愈率（38.2％）、缓解率（17.7％）高于对照组,而无效或复发率（44.1％）低于对照组,差异均有统计学意义（P＜0.05）.醋酸曲普瑞林亚组不良反应明显多于反添加亚组,差异有统计学意义（P＜0.05）.结论：子宫内膜异位症患者腹腔镜术后联合应用GnRHa可以提高治愈率,降低复发率,1个月后同时应用反添加疗法,可以减少不良反应的发生.

Efficacy of Laparoscopic Surgery Combined with Gonadotropin-Releasing Hormone Agonist in Patients with Endometriosis

Objective：To evaluate the effectiveness of laparoscopic surgery combined with gonadotropin-releasing hormone agonist（GnRHa） for endometriosis（EMs）.Methods：The clinical datum of 98 women with EMs who were treated from Sep 2007 to Dec 2010 were retrospectively analyzed.All patients were divided into GnRHa group（n =64）and control group（n =34）after laparoscopic surgery.The patients in GnRHa group were administered by GnRHa injection（3.75 mg） at the fifth day,once every 28 days,for three times.GnRHa group was divided into two subgroups.Diphereline subgroup（n =33）after laparoscopic surgery was given injection of Diphereline only.Patients in add back therapy subgroup（n =31） were given injection of Diphereline only for 1 month and then given Premarin 0.3 mg and progestin 2.0 mg at the same time.All the patients were followed up for 12 months after surgery to evaluate the therapeutic effect.Cure rate,remission rate,invalid rate or recurrence rate in three groups were observed.The side reactions of Diphereline subgroup and add back therapy subgroup were observed.Results：In Diphereline subgroup and add back therapy subgroup,cure rate,remission rate and invalid rate or recurrence rate were 57.6 ％,36.3 ％,6.1 ％ and 58.1％,32.2％,9.7％,respectively.There was no significant difference between the two subgroups（P＞0.05）.However,in the two subgroups,cure rate（38.2 ％） and remission rate（17.7 ％） were higher than those in control group,while recurrence rate（44.1％） was lower than that in control group,and there were significant differences （P＜0.05）.The rate of side reactions was higher in Diphereline subgroup than that in add back therapy subgroup（P＜0.05）.Conclusions：After laparoscopic surgery,combination with GnRHa for EMs can improve the cure rate and reduce the recurrence rate.From the second month,combined with add back therapy can reduce the rate of side reactions of GnRHa.