米非司酮对保守性手术后子宫内膜异位症临床治疗效果的观察

目的:探讨子宫内膜异位症患者保守性手术后服用米非司酮巩固治疗的临床疗效及其对内分泌的影响。方法:选择2003年1月至2005年1月行保守性手术的盆腔子宫内膜异位症患者70例,随机分为3组。米非司酮组30例,给予米非司酮12.5mg口服,每天1次,于手术后第1次月经来潮5天内开始用药,疗程为6个月。GnRH-a组20例,于手术后第1次月经来潮5天内,腹部皮下注射戈舍瑞林(商品名:诺雷得)3.6mg,28天注射1次,共6次。对照组20例患者手术后不用药物巩固治疗。比较分析应用米非司酮和GnRH-a治疗子宫内膜异位症的疗效、副反应及对垂体-卵巢轴内分泌的影响。结果:3组患者痛经症状都得到不同程度的缓解,米非司酮组和GnRH-a组的完全缓解率分别为87%和90%,明显高于对照组的55%,差异有统计学意义(P<0.05)。米非司酮组和GnRH-a组累积复发率分别为7%和5%,显著低于对照组(P<0.05)。米非司酮组和GnRH-a组之间的完全缓解率和累积复发率均无统计学差异(P>0.05)。结论:米非司酮用于盆腔子宫内膜异位症患者保守性手术后的巩固治疗有效,可预防和减少复发,而且副反应小,对内分泌代谢及骨密度无明显影响。

Clinical observation of endometriotic patients treated with mifepristone after conservative surgery

Objective:To evaluate the efficacy and side effects of mifepristone on endometriotic patients after conservative surgery and the effects of endocrine response.Methods:Seventy women with endometriosis after conservative surgery were divided into three groups randomly.Thirty cases in the mifepristone group received mifepristone 2.5mg/d for 6 months.Twenty cases in the group of gonadotropin releasing hormone(GnRH-a)received Goserelin 3.6mg,once per twenty-eight days for 6 months.Twenty cases in the control group did not receive any postoperative medical treatment.Results:Pelvic pain and uterine cramping of all patients were relieved;both mifepristone group and GnRH-a treatment group achieved significant relief of pelvic symptons and signs than that of the control group(P<0.05).The cumulative recurrence rates of mifepristone group and GnRH-a group were 7% and 5% respectively,significantly lower than those of control group(P<0.05).There were no significant difference between mifepristone group and GnRH-a group(P>0.05).Conclusion:Treatment of endometriosis with mifepristone appears to be effective in improving the symptoms and signs without significant effect on blood sex hormone and bone density.