腹腔镜术后联合GnRH-a治疗子宫内膜异位症合并不孕患者主观症状、性激素水平及妊娠结局
|
摘要
目的:探讨腹腔镜联合促性腺激素释放激素激动剂(GnRH-a)治疗子宫内膜异位症(EMT)合并不孕的临床疗效。方法:将本院收治的104例EMT合并不孕患者根据治疗方法不同分为两组各52例,两组患者均行腹腔镜手术治疗,观察组术后应用GnRH-a,对照组术后口服避孕药。观察两组治疗前后观察指标变化,随访妊娠率、复发率。结果:观察组术后6个月时的盆腔症状、体征评分及主观症状总评分,以及LH、FSH、E_2水平低于对照组(P<0.05)。抗苗勒管激素(AMH)水平手术前后两组比较无差异(P>0.05)。观察组治疗总有效率(92.3%)高于对照组(76.9%)(P<0.05)。两组术后6月的窦卵泡数目(AFC)个数均较术前减少,但观察组高于对照组,用药后不良反应发生率高于对照组,观察组术后2年的自然妊娠率及足月产率均高于对照组,复发率低于对照组(均P<0.05)。结论:腹腔镜术后联合应用GnRH-a治疗EMT合并不孕症,能够有效改善患者的主观症状,降低雌孕激素水平,保护卵巢功能,预防疾病复发,提高妊娠率。
Objective: To investigate the clinical efficacy of laparoscopy combined with GnRH-a for treating infertility women with endometriosis(EMT). Methods: 104 infertility women with EMT were selected and divided into two groups according to the different treatment methods(52 cases in each group). All included women were treated by laparoscopic surgery, and then the women in study group were given GnRH-a, and the women in control group were given oral contraceptives. The subjective symptoms, sex hormone levels, and antral follicles number of women was observed before and after treatment, the pregnancy rate, and the relapse rate of women were followed up. Results: The scores of pelvic symptoms, signs and subjective symptoms, and the levels of LH, FSH and E_2 of women in study group were significant lower than those of women in control group in the 6 th month after operation(P<0.05). There was no significant difference in AMH level between the two groups before and after operation(P>0.05). The total effective rate of study group was 92.3%, which was significant higher than that(76.9%) of control group(P<0.05). The number of AFC of women in both groups had decreased significantly in the 6 th month after operation, but the number of AFC of women in study group was significant lower than that of women in control group. In 2 years after operation, the rate of natural pregnancy and full-term delivery of women in study group were significant higher than those of women in control group, but the recurrence rate was significant lower than that of women in control group(P<0.05). The total incidence of adverse reaction of women in study group was significant higher than that of women in control group(P<0.05). Conclusion: Laparoscopy combined with GnRH-a for treating infertility women with EMT can effectively alleviate subjective symptoms, reduce estrogen and progesterone levels, protect ovarian function, prevent disease recurrence, and improve pregnancy rates.
Objective: To investigate the clinical efficacy of laparoscopy combined with GnRH-a for treating infertility women with endometriosis(EMT). Methods: 104 infertility women with EMT were selected and divided into two groups according to the different treatment methods(52 cases in each group). All included women were treated by laparoscopic surgery, and then the women in study group were given GnRH-a, and the women in control group were given oral contraceptives. The subjective symptoms, sex hormone levels, and antral follicles number of women was observed before and after treatment, the pregnancy rate, and the relapse rate of women were followed up. Results: The scores of pelvic symptoms, signs and subjective symptoms, and the levels of LH, FSH and E_2 of women in study group were significant lower than those of women in control group in the 6 th month after operation(P<0.05). There was no significant difference in AMH level between the two groups before and after operation(P>0.05). The total effective rate of study group was 92.3%, which was significant higher than that(76.9%) of control group(P<0.05). The number of AFC of women in both groups had decreased significantly in the 6 th month after operation, but the number of AFC of women in study group was significant lower than that of women in control group. In 2 years after operation, the rate of natural pregnancy and full-term delivery of women in study group were significant higher than those of women in control group, but the recurrence rate was significant lower than that of women in control group(P<0.05). The total incidence of adverse reaction of women in study group was significant higher than that of women in control group(P<0.05). Conclusion: Laparoscopy combined with GnRH-a for treating infertility women with EMT can effectively alleviate subjective symptoms, reduce estrogen and progesterone levels, protect ovarian function, prevent disease recurrence, and improve pregnancy rates.
引文
[1] 李焱,张震宇,刘崇东.子宫内膜异位症合并不孕患者腹腔镜术后药物治疗妊娠结局分析[J].实用妇产科杂志,2015,31(1):53-56.
[2] 任红英,黄玉琴.促性腺激素释放激素-a联合反向添加疗法应用重度子宫内膜异位症腹腔镜术后的临床研究[J].山西医药杂志,2018,47(2):191-193.
[3] 张雯,杜昊,俎丽,等.子宫内膜异位症腹腔镜术后治疗网络Meta分析[J].中国医药导报,2018,15(3):97-101.
[4] 李颖.腹腔镜手术联合米非司酮治疗子宫内膜异位症59例临床疗效观察[J].承德医学院学报,2018,35(2):116-118.
[5] 马玉桂.GnRH-a联合去氧孕烯炔雌醇辅助腹腔镜手术治疗子宫内膜异位症患者的疗效研究[J].国外医学(医学地理分册),2018,39(2):156-158,161.
[6] 何丽清,蔡序子,王艳,等.子宫内膜异位症腹腔镜保守治疗术后联用GnRHa对临床妊娠率的影响[J].南方医科大学学报,2018,38(5):596-600.
[7] Ji-Ming Chen,Hong-Yan Gao,Yi Ding,et al.Efficacy and Safety Investigation of Kuntai Capsule for the Add-back Therapy of Gonadotropin Releasing Hormone Agonist Administration to Endometriosis Patients:A Randomized,Double-blind,Blank- and Tibolone-controlled Study[J].Chinese Medical Journal,2015,128(4):427-432.
[8] 高志红.腹腔镜手术联合GnRH-a治疗卵巢子宫内膜异位囊肿患者的临床观察[J].广西医科大学学报,2016,33(01):137-139.
[9] Bedaiwy MA,Allaire C,Alfaraj S.Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy[J].Fertility and sterility,2017,107(3):537-548.
[10] 王艳平,孙海燕.GnRH-a、孕三烯酮用于卵巢子宫内膜异位囊肿患者术后假孕治疗效果比较[J].山东医药,2016,56(26):56-58.
[11] 秦娟,宋国林,刘卿,等.GnRH-a与去氧孕烯炔雌醇片对子宫内膜异位症血管生成素-2的影响[J].中国妇产科临床杂志,2016,17(04):363-365.
[12] 陈敏,王远菊,王彩霞.腹腔镜下卵巢子宫内膜异位囊肿剥除术前使用GnRH-a预处理对卵巢储备功能的影响[J].现代妇产科进展,2016,25(10):772-774.
[2] 任红英,黄玉琴.促性腺激素释放激素-a联合反向添加疗法应用重度子宫内膜异位症腹腔镜术后的临床研究[J].山西医药杂志,2018,47(2):191-193.
[3] 张雯,杜昊,俎丽,等.子宫内膜异位症腹腔镜术后治疗网络Meta分析[J].中国医药导报,2018,15(3):97-101.
[4] 李颖.腹腔镜手术联合米非司酮治疗子宫内膜异位症59例临床疗效观察[J].承德医学院学报,2018,35(2):116-118.
[5] 马玉桂.GnRH-a联合去氧孕烯炔雌醇辅助腹腔镜手术治疗子宫内膜异位症患者的疗效研究[J].国外医学(医学地理分册),2018,39(2):156-158,161.
[6] 何丽清,蔡序子,王艳,等.子宫内膜异位症腹腔镜保守治疗术后联用GnRHa对临床妊娠率的影响[J].南方医科大学学报,2018,38(5):596-600.
[7] Ji-Ming Chen,Hong-Yan Gao,Yi Ding,et al.Efficacy and Safety Investigation of Kuntai Capsule for the Add-back Therapy of Gonadotropin Releasing Hormone Agonist Administration to Endometriosis Patients:A Randomized,Double-blind,Blank- and Tibolone-controlled Study[J].Chinese Medical Journal,2015,128(4):427-432.
[8] 高志红.腹腔镜手术联合GnRH-a治疗卵巢子宫内膜异位囊肿患者的临床观察[J].广西医科大学学报,2016,33(01):137-139.
[9] Bedaiwy MA,Allaire C,Alfaraj S.Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy[J].Fertility and sterility,2017,107(3):537-548.
[10] 王艳平,孙海燕.GnRH-a、孕三烯酮用于卵巢子宫内膜异位囊肿患者术后假孕治疗效果比较[J].山东医药,2016,56(26):56-58.
[11] 秦娟,宋国林,刘卿,等.GnRH-a与去氧孕烯炔雌醇片对子宫内膜异位症血管生成素-2的影响[J].中国妇产科临床杂志,2016,17(04):363-365.
[12] 陈敏,王远菊,王彩霞.腹腔镜下卵巢子宫内膜异位囊肿剥除术前使用GnRH-a预处理对卵巢储备功能的影响[J].现代妇产科进展,2016,25(10):772-774.