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中重度子宫内膜异位症患者腹腔镜保守性手术后应用与不应用促性腺激素释放激素激动剂治疗的比较性疗效分析
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DOI:
作者:
车璇
CHE Xuan,ZHANG Jing, ZHANG Xinmei.
作者单位:
嘉兴妇幼保健院
Jiaxing Maternity and Child Health Care Hospital
关键词:
子宫内膜异位症、腹腔镜、手术、促性腺激素释放激素激动剂
Endometriosis;Laparoscopy; surgery; Gonadotropin-releasing hormone agonist
摘要:
目的: 评价中重度子官内膜异位症(内异症)患者腹腔镜保守性手术后应用促性腺激素释放激素激动剂(GnRHa)治疗的疗效。方法: 选择2007年1月至2008年4月在浙江大学医学院附属妇产科医院住院行腹腔镜保守性手术并经病理证实中重度内异症【按1997年修改的美国生育协会(rAFS)分期】的160例患者,按术后GnRHa治疗3个月(n=50,研究I组)与6个月(n=52,研究II组)以及期待治疗(n=58,对照组)分成三组,观察三组患者术后的治疗情况。患者疼痛严重程度采用视觉模拟评分方法(VAS)进行评价。结果: 随访的中位时间为55.5月(48-63),17例患者失访。 研究I与II组以及对照组的临床有效率分别为90.0%、93.6%和92.4%;复发率分别为11.6%、12.8%和20.8%;内异症合并不孕患者术后妊娠率分别为54.5%,60.0%,53.8%。三组患者术后的临床有效率、复发率及妊娠率之间比较,差异均无显著性(P>0.05)。研究I与II组患者术后疼痛评分分数显著低于对照组(1.5±0.5 & 1.3±0.5 versus 2.7±0.4, P<0.01)。经The Kaplan-Meier生存曲线分析,研究I组的复发率大于研究II组,但小于对照组。结论:中重度内异症腹腔镜保守手术后应用GnRHa治疗可能有利改善患者的疼痛症状和延缓复发, 但术后GnRHa治疗6个月似乎优于3个月。
Objective: To evaluate the efficacy of gonadotropin releasing hormone agonist (GnRHa) treatment for women with advanced endometriosis after laparoscopic conservative surgery. Methods: Between January 2007 and April 2008, a total of 160 women with endometriosis undergoing laparoscopic conservative surgery were recruited in this study. Endometriosis was graded according to the Revised American Fertility Society scoring (rAFS) system, and all women had stage III and IV of endometriosis. After surgery, women were treated with GnRHa for 3 months (n = 50, case group I) and 6 months (n=52, case group II) in comparison to expectant management (n=58, control group). Pain was evaluated by using a visual analogue scale (VAS). Results: The median time (range) of following up was 55.5 months (48-63), and 17 patients were lost. . The rate of efficacy in case group I and II as well as control group was 90.0%,93.6% and 92.4%, respectively. The rates of recurrence and pregnancy were 11.6% and 54.5% in case group I, 12.8% and 60.0% in case group II, and 20.8% and 53.8% in control group, respectively.There were no signfficant differences with respect to the rates of efficacy, reccurence and pregnancy between the case and control groups (P>0.05).Pain VAS scores in the case group I and II were both significantly lower than those in the control group (1.5±0.5 & 1.3±0.5 versus 2.7±0.4,P<0.01). The cumulative probabilities of disease recurrence by using the Kaplan-Meier method analysis were higher in the case group I in comparison to the case group II, and lower as compared with the control group. Conclusions: GnRHa therapy, especially for 6 months, may be beneficial to pain relief and recurrence delay in women with advanced endometriosis after conservative laparoscopic surgery.
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