GnRH-a对有再生育需求的中、重度内异症患者腹腔镜术后的临床疗效

目的 观察腹腔镜术后使用Gn RH-a (促性腺激素释放激素激动剂) 对有再生育需求的中、重度子宫内膜异位症患者的临床疗效.方法 选取昆明市妇幼保健院2015年01月到2016年12月诊断为子宫内膜异位症症III期或IV期的100例患者, 在行腹腔镜保守性手术后随机分为实验组和对照组, 实验组患者术后肌注“注射用醋酸曲普瑞林” (商品名:达菲林) 3.75 mg共6周期, 对照组术后不使用任何药物.治疗后随访1 a, 观察2组术后糖类抗原125 (CA125) 值、盆腔疼痛VAS, 复发率及自然妊娠率有无差别.结果 (1) 2组术前与术后CA125值比较差异无统计学意义 (P>0.05) ; (2) 实验组疼痛VAS与对照组VAS术前、术后比较差异无统计学意义 (P>0.05) ; (3) 实验组复发2例, 复发率4%, 对照组复发4例, 复发率8%;比较复发率差异有统计学意义 (P<0.05) ; (4) 实验组自然妊娠率:30%;其中子宫内膜异位症III期患者中妊娠9例, 子宫内膜异位症IV期患者中妊娠6例.对照组自然妊娠率:14%;其中子宫内膜异位症III期患者中妊娠6例, 子宫内膜异位症IV期患者中妊娠1例;比较实验组与对照组妊娠率差异有统计学意义 (P<0.05) .对照组中III期、IV期的妊娠人数有差异 (P<0.05) .组间比较实验组与对照组III期、IV期的妊娠人数显示实验组与对照组内异症IV期的妊娠人数有统计学差异 (P<0.05) .实验组中年龄大于35岁病例中妊娠3例;对照组中妊娠1例, 比较实验组与对照组年龄大于35岁以上的妊娠率显示有统计学差异 (P<0.05) .结论 腹腔镜术后应用Gn RH-a对于有再生育需求的中、重度子宫内膜异位症患者, 可以降低患者复发率, 提高年龄大于35岁患者及分期高患者的自然妊娠率.

Clinical Efficacy of GnRH-a in Patients with Moderate or Severe Endometriosis After Laparoscopic Surgery

Objective To observe the clinical efficacy of gonadotropin-releasing hormone agonist (Gn RH-a) in patients with moderate or severe endometriosis after laparoscopic surgery. Methods From January2015 to December 2016, 100 patients who were diagnosed with moderate (stage III) or severe (stage IV) endometriosis were enrolled in a randomized clinical trial in Kunming Maternal and Child Health Hospital. After receiving conservative laparoscopic surgery, patients were randomly divided into a treatment group and a control group. The patients in the treatment group were injected 3.75 mg Gn RH-a (commodity name: Dafilin) for 6 times as a complete treatment. The control group did not receive any drugs after surgery. The two groups were followed up for one year to observe the difference of carbohydrate antigen 125 (CA125) value, VAS scores of pelvic pain, recurrence rate and pregnancy rates between the two groups.Re s ults (1) There was no significant difference between the two groups in CA125 value before and after operation (P>0.05) . (2) No significant difference was observed in VAS scores between two groups before and after surgery (P>0.05) . (3) The treatment group had 4 cases of recurrence (recurrence rate of 4%) , and the control group had 8 cases (8% of recurrence rate) . The comparison of recurrence rate between groups was significantly different (P<0.05) . (4) The pregnancy rate was30% in the treatment group while that was 14 % in the control group. The observed difference in pregnancy rates was statistically significant (P<0.05) . Besides, in the treatment group, 9 patients with stage III endometriosis and 6 patients with stage IV were pregnant while in the control group, the number ofpregnant patients were 6 and 1 in patients with stage III and IV endometriosis.The difference in number of pregnant patients with different stages was statistically significant between two groups (P<0.05) .The in-group comparison showed that there was a significant difference in the number of pregnancies in patient with stage IV endometriosis between the treatment group and the control group (P<0.05) . Age stratified analysis revealed that the pregnant rate among patients aged over 35 was significantly higher in the treatment group than that in the control group (with P <0.05) .Conclus ion Laparoscopic Gn RH-a can reduce the recurrence rate of moderate and severe endometriosis and increase the rate of spontaneous pregnancy in patients over 35 years of age and patients with moderate or severe endometriosis.