腹腔镜手术联合药物治疗子宫内膜异位症的疗效对比观察

目的对比观察腹腔镜手术后联合应用不同药物治疗子宫内膜异位症（Endometriosis,EMS）的临床疗效。方法子宫内膜异位症r-AFSⅠ～Ⅱ期患者92例,均于腹腔镜手术后分别应用促性腺激素释放激素激动剂（GnRH-α）、孕三烯酮及米非司酮。对比治疗前后的痛觉评分、CA125水平、子宫活动度、子宫内膜厚度及并发症发生率情况。结果 13组治疗前临床资料均一,具有可比性;2手术联合3种药物治疗前后各指标对比P〈0.05,疗效显著。组间比较,GnRH-α组能改善患者痛经情况,米非司酮组能减少并发症发生率,而在降低CA125水平、改善子宫活动度及减少子宫内膜厚度方面3组效果相当;31年随访结果显示GnRH-α组改善痛经效果较其他2组佳,而米非司酮组改善患者生育能力较其他2组强,但复发率相对较高。结论三类药物用于子宫内膜异位症腹腔镜术后辅助治疗效果确切,各有其优缺点,临床工作中应根据患者具体情况酌情选用最佳辅助方案。

Curative efficacy evaluation of different drugs combined with laparoscopic surgery for endometriosis

Objective To compare the clinical efficacy of different drugs combined with laparoscopic surgery in the treatment of endometriosis（EMS）. Methods 92 cases of patients with endometriosis of Ⅰ- Ⅱ period（ r-AFS staging criteria） were included in this study,they were treated with gonadotropin-releasing hormone agonist（ GnRH-α）,gestrinone or mifepristone after laparoscopic surgery. The pain scores,CA125 levels,activity of uterus,endometrial thickness and incidence of complications before and after the treatment were compared. Results 1The clinical data of three groups before the treatment was uniform and comparable;2The comparison of curative efficacy before and after the treatments showed that all of the three drugs had therapeutic values（P〈0. 05）. GnRH-α could effectively improve the dysmenorrheal,while mifepristone could reduce the incidence of complications;The three medicines had the same effects in lowering the levels of CA125,improving the activity of uterus and decreasing the endometrial thickness. 3The results of 1 year follow-up showed that GnRH-α group had better effect in improving dysmenorrhea than the other two groups,and mifepristone group had better effect in improving fertility and higher recurrence rate than the other two groups. Conclusion All of the three drugs are effective in the treatment of endometriosis after laparoscopic surgery,each have their advantages and disadvantages,and the clinical application of them should be selected according to specific circumstances as appropriate.