【作者】 马银芬； 陈萍；

【Author】 MA Yinfen;CHEN Ping;Shaoxing Second Hospital;

【机构】 绍兴第二医院；

【摘要】 目的:探讨曲普瑞林联合左炔诺孕酮宫内缓释系统(LNG-IUS,商品名曼月乐)用于中重度子宫内膜异位症(EMs)保守性手术后巩固治疗的疗效。方法:选择腹腔镜或开腹保守性手术后中重度EMs、无生育要求、术前主痛经的患者123例,随机分为3组,A组43例,术后使用曲普瑞林联合曼月乐治疗,B组40例,术后单纯使用GnRHa治疗,C组40例,术后单纯使用曼月乐治疗。随访2年,比较手术前、手术后3个月、6个月、9个月、术后1年及2年疼痛评分、CA125值、复发率及不良反应。结果:3组术后各时间点的疼痛评分均低于术前(P<0.05);A组、C组中术后各时间点的疼痛评分无统计学差异;B组中术后1年、2年疼痛评分均高于术后3个月、6个月和9个月(P<0.05);在术后1年、2年A组、C组的疼痛评分低于B组(P<0.05)。3组术后各时间点CA125值均低于术前(P<0.05);A组、C组中术后各时间点CA125值无统计学差异。B组中术后1年、2年CA125值均显著高于术后3个月、6个月和9个月(P<0.05)。术后1年、2年A组、C组的CA125低于B组(P<0.05)。术后1年复发率A组为0.0%,B组为12.5%,C组为2.5%;术后2年复发率A组为4.70%,B组为30.0%,C组为7.5%;同期复发率A、C组明显低于B组(P<0.05)。不良反应:A组放置曼月乐后的6个月内出现阴道点滴状出血或不规则出血发生率低于C组(P<0.05),但放置曼月乐1年、2年后差异无统计学意义,随访1年A组未见节育器下移和脱落,C组节育环下移2例,脱落1例,随访2年A组3例闭经,10例月经稀发,C组4例闭经,9例月经稀发,无节育环下移及脱落;B组注射GnRHa3月后多数患者出现绝经期症状。结论:GnRHa联合曼月乐用于中、重度EMs保守性手术后,可以长时间缓解疼痛,降低术后复发率,还可减少不规则阴道流血,防止环位下移或脱落,同时也降低患者的经济费用,是一种行之有效的巩固治疗方法,值得临床推广应用。更多还原

【Abstract】 Objective:To explore the efficacy of gonadotropin releasing hormone agonist(GnRHa) combined with levonorgestrel releasing intrauterine system(LNG-IUS,trade name Mirena) in the consolidation treatment of moderate to severe endometrosis(EMs) after conservative surgery.Methods:One hundred twenty-three patients with moderate to severe Ems,no fertility requirements,with primary dysmenorrhea before operation,after conservative surgery were randomly divided into 3 groups,group A in which 43 women were given triptorelin and LNG-IUS therapy,group B in which 40 women were given triptorelin therapy only,group C in which 40 women were given LNG-IUS therapy only.The follow-up period was 2 years.The mean visual analogue scale(VAS) scores of their pains,serum CA125 levels,recurring rate and adverse reaction between the three groups and between pre-therapy and post-therapy were compared.Results:In three groups,significant differences(P<0.05) existed in VAS scores at the end of 3-month,6-month,9-month,12-month and 2 years treatment when compared with the preoperative situation.In group A,C,there were no statistical differences in VAS scores among different times after post-operation.In group B,the VAS score at the end of 12-month and 2year treatment was significantly higher than that at the end of 3-month,6-month and 9-month treatment(P<0.05).At the end of 12-month and 2year treatment,the VAS scores in group A,C were significantly lower than those in group B.In three groups,significant differences(P<0.05) existed in serum CA125 at the end of 3-month,6-month,9-month,12-month and2 year treatment when compared with the preoperative situation.In group A,C,there were no statistical differences in the value of serum CA125 among different times after post-operation.In group B,the value of serum CA125 at the end of 12-month and 2 year treatment was significantly higher than that at the end of 3-month,6-month and 9-month treatment(P <0.05).At the end of 12-month and 2 years treatment,the value of serum CA125 in group A,C was significantly lower than that in group B.After 1-year treatment,the recurrence rate was 0%in group A,12.5%in group B,and 2.5%in group C;After 2-year treatment the rrecurrence rate was 4.70%in group A,30%in group B,and 7.5%in group C;the recurrence rate of group A,C in the same period was obviously lower than that in group B(P <0.05).Adverse reaction:The rate of vaginal guttate bleeding or irregular bleeding after LNG-IUS inserted witnin 6 months in group A was lower than that in group C(P <0.05),but there were no statistically significant differences after 1 and 2 years treatment.Follow-up of 1 years,no case of IUD down and fall off in group A,2 cases of IUD down and 1 case of fall off in group C.Followed up for 2 years,3 cases of amenorrhea and 10 cases of oligomenorrhea in group A,4 cases of amenorrhea and 9 cases of oligomenorrhea in group C,no IUD down and fall off in group A,C;most patients appear menopausal symptoms after 3 months with triptorelin in group B.Conclusion:Triptorelin combined with LNG-IUS in the consolidation treatment of moderate to severe EMs after conservative surgery,can long time to relieve pain,reduce the recurrence rate after operation,but also reduce the irregular vaginal bleeding,to prevent the IUD down or fall off,but also reduce the cost for the patient,is a kind of effective consolidation treatment,worthy of clinical application.更多还原