重度子宫内膜异位症腹腔镜术后联合GnRHa治疗效果及反加疗法的影响

目的:分析重度子宫内膜异位症患者腹腔镜术后联合GnRHa治疗中,应用反加疗法与否对临床疗效及副反应的影响,探讨短期应用GnRHa联合反加治疗的必要性和时机。方法:回顾分析2003年3月至2006年6月行保守性腹腔镜手术且手术证实为盆腔子宫内膜异位症,部分合并子宫腺肌症、术后应用GnRHa治疗3个月87例患者的临床资料,包括患者疼痛症状、不孕情况、体征、血清CA125、临床病理类型、手术过程、术后用药及随诊情况,根据是否应用反加疗法分成两组。统计分析用药疗效、月经恢复状态、副反应及复发情况。停药后定期随诊,随诊时间为12～28个月,平均18.25个月。结果:34例患者出现明显低雌症状,予以反加治疗(倍美力0.3mg+安宫黄体酮2mg)/d。两组治疗后疼痛VAS评分、体征改善、血清CA125均较治疗前有统计学差异(P<0.05);治疗后两组疗效及月经恢复间隔无统计学差异(P>0.05)。49例不孕患者手术用药后自然妊娠12例,辅助生殖妊娠6例,妊娠率36.74%;自然妊娠时间为停药后2～22个月,平均9.5±5.5个月,自然妊娠率为24.48%。复发平均时间为末次GnRHa用药后12.81±5.5个月;复发23例,1年内复发13例(14.94%),2年累计复发率26.43%。疼痛复发率8/87(9.2%),体征复发率20/87(22.99%)。两组复发率,复发类型及复发间隔无统计学差异(13.8%vs12.6%,P=0.133;12.13±6.15个月vs12.75±5.60个月,P=0.881)。结论:腹腔镜术后辅以GnRHa治疗重度子宫内膜异位症提高了手术成功率,有效抑制了疼痛复发。适时反向添加治疗可缓解用药副反应,不影响疗效及复发。

Effect of addback therapy on Gonadotropin-releasing hormone analogues treatment for severe endometriosis after laparoscopic surgery.

Objective：To explore the clinical valuation of short-term GnRHa combined with addback therapy by analyzing the efficacy and side-effect of GnRHa treatment for severe endometriosis after laparoscopic surgery. Methods：Clinical data of severe endometriosis patients who underwent GnRHa treatment after laparoscopic surgery in Perking Union Medical College Hospital from 2003 to 2006 were retrospectively analyzed. According to whether receiving addback therapy two groups were divided and the clinical data were compared. Results ：Thirty four patients occurs severe low estrogen symptoms when 2nd GnRHa injection, and receive conjugated estrogen 0.3rag ± MPA 2mg/d. VAS, physical sign and CA125 were significantly different between pre- therapy and post-therapy in both groups （P 〈 0.05 ）, however, there were no significant differ- ences between two groups after treatments （P 〉 0.05 ）. 18 out of 49 infertility patients were preg- nant after treatments（36.74% ）. The recurrence rate was 26.43% within 2 years after treatments,the mean recurrence time was 12.81 ±5.5 months after GnRHa withdraw. There were no significant differences between two groups in recurrence rates, clinical recurrence types and recurrence interval （ 13.8% vs 12.6%, P = 0. 133 ; 12.13 ± 6.15 months vsl2.75 ± 5.60 months, P = 0. 881）. Conclusion： GnRHa treatment for severe endometriosis after laparoscopic surgery can in- hibit pelvic pain recurrence effectively,low-dose conjugated estrogens add-back therapy can re- lieve the side-effect of GnRHa and has no effect on treatment results and recurrence.