达菲林联合腹腔镜术治疗子宫内膜异位症的临床效果
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摘要
目的探讨达菲林联合腹腔镜术治疗子宫内膜异位症的临床效果。方法选择2016年1月～2017年10月浙江省永康市第一人民医院收治的103例子宫内膜异位症患者,按随机数字表法分为对照组(51例)和观察组(52例)。对照组采用腹腔镜术治疗,观察组采用达菲林联合腹腔镜术治疗。评价并比较两组患者有效率、治疗前后盆腔包块大小、子宫内膜异位症生存质量评分(EHP-5评分)、痛经视觉模拟评分(VAS)及性激素水平、血管相关指标水平变化,记录并比较两组不良反应发生率。结果观察组的总有效率高于对照组(P <0.05);治疗后,两组盆腔包块大小、EHP-5评分、痛经VAS评分低于本组治疗前,且观察组低于对照组,差异均有统计学意义(P <0.05);治疗后,两组促黄体生成素(LH)、雌二醇(E2)、卵泡刺激素(FSH)、血管生长因子(VEGF)、血管生成素(Ang)-2和血管生成素受体-2(Tie-2)水平低于本组治疗前,且观察组低于对照组,差异均有统计学意义(P <0.05);两组不良反应发生率比较,差异无统计学意义(P> 0.05)。结论达菲林联合腹腔镜术治疗子宫内膜异位症的临床效果显著,能够明显降低机体的性激素水平、VEGF、Ang等相关因子的表达水平,提高子宫内膜异位症患者的临床治疗效果,为临床研究提供了一定思路。
Objective To investigate the clinical effect of Diphereline combined with laparoscopy surgery in the treatment of endometriosis. Methods A total of 103 patients with endometriosis admitted to the First People′s Hospital of Yongkang City, Zhejiang Province were selected from January 2016 to October 2017, and they were divided into control group(51 cases) and observation group(52 cases) according to random table method. The control group was treated with laparoscopic surgery, the observation group was treated with Diphereline combined with laparoscopic surgery. The effective rate, pelvic mass size, quality of life score for endometriosis(EHP-5), dysmenorrhea visual analogue scale(VAS),sex hormone level and vascular related indices were evaluated and compared between the two groups before and after treatment. The incidence of adverse reactions was recorded and compared between the two groups. Results The total effective rate of the observation group was higher than the control group(P < 0.05). After treatment, the pelvic mass size,EHP-5 score and dysmenorrhea VAS score in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05).After treatment, the levels of luteinizing hormone(LH), estradiol(E2), follicle-stimulating hormone(FSH), vascular growth factor(VEGF), Angiopoietin(Ang)-2 and Angiopoietin receptor(Tie)-2 in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05). Conclusion The clinical efficacy of Diphereline combined with laparoscopy surgery in the treatment of endometriosis is remarkable, it can significantly reduce the body′s sex hormone level, VEGF, Ang and other related factors expression level, and improve the clinical treatment effect of endometriosis, which can provide some ideas for clinical research.
Objective To investigate the clinical effect of Diphereline combined with laparoscopy surgery in the treatment of endometriosis. Methods A total of 103 patients with endometriosis admitted to the First People′s Hospital of Yongkang City, Zhejiang Province were selected from January 2016 to October 2017, and they were divided into control group(51 cases) and observation group(52 cases) according to random table method. The control group was treated with laparoscopic surgery, the observation group was treated with Diphereline combined with laparoscopic surgery. The effective rate, pelvic mass size, quality of life score for endometriosis(EHP-5), dysmenorrhea visual analogue scale(VAS),sex hormone level and vascular related indices were evaluated and compared between the two groups before and after treatment. The incidence of adverse reactions was recorded and compared between the two groups. Results The total effective rate of the observation group was higher than the control group(P < 0.05). After treatment, the pelvic mass size,EHP-5 score and dysmenorrhea VAS score in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05).After treatment, the levels of luteinizing hormone(LH), estradiol(E2), follicle-stimulating hormone(FSH), vascular growth factor(VEGF), Angiopoietin(Ang)-2 and Angiopoietin receptor(Tie)-2 in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05). Conclusion The clinical efficacy of Diphereline combined with laparoscopy surgery in the treatment of endometriosis is remarkable, it can significantly reduce the body′s sex hormone level, VEGF, Ang and other related factors expression level, and improve the clinical treatment effect of endometriosis, which can provide some ideas for clinical research.
引文
[1]Dunselman GA,Vermeulen N,Becker C,et al.ESH REguideline:management of womenwith endometriosis[J]Hum Reprod,2014,29(3):400-412.
[2]覃正文.腹腔镜联合亮丙瑞林治疗子宫内膜异位症伴不孕的价值分析及对患者生育能力的影响[J].中国妇幼保健,2017,32(1):113-115.
[3]Granese R,Perino A,Calagna G,et al.Gonadotrophin-releasinghormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis:a multi-center randomized trial[J].Acta Obstet Gynecol Scand,2015,94(6):637-645.
[4]赵晋,李红霞,顾蓓.子宫内膜异位症术后达菲林与达那唑辅助治疗的临床观察[J].实用临床医药杂志,2012,11(5):348-349.
[5]赵淑芬,曹华.腹腔镜术联合达菲林治疗子宫内膜异位症的临床疗效及对患者血清IL-6、Syndecan-1表达的影响[J].中国妇幼保健,2018,33(12):2663-2666.
[6]王丹,李怀芳.达菲林联合腹腔镜术治疗子宫内膜异位症对VEGF,Ang-2和Tie-2水平的影响[J].中国妇幼健康研究,2016,27(8):994-997.
[7]许希中.子宫内膜异位症伴不孕患者腹腔镜术后不同治疗方法对妊娠率的影响[J].重庆医学,2014,43(5):611-612,627.
[8]张瑞霞,刘增娟,谢伟,等.腹腔镜诊断盆腔子宫内膜异位症及对不孕症患者的疗效观察[J].中国计划生育和妇产科,2012,4(2):41-45.
[9]贾慧娟,胡玉玲,裴俊利,等.腹腔镜下子宫内膜异位症术后不同处理方法的临床疗效比较[J].疑难病杂志,2013,12(4):290-292.
[10]张丽萍.经腹部超声与经阴道超声诊断子宫内膜异位症的价值对比[J].临床医学研究与实践,2017,2(29):143-144.
[11]张媛,刘筱茂,霍艳宁,等.中药口服联合保留灌肠治疗子宫内膜异位症生存质量及疗效评价[J].环球中医药,2017,10(7):712-715.
[12]徐丽梅,郑志峰,毛俊涛,等.中医灸法护理干预在原发性痛经中的应用及对VAS评分的影响研究[J].实用妇科内分泌电子杂志,2017,4(9):50-51.
[13]严雪文,廖艳婷,尚雪.子宫内膜异位症术后应用达菲林的价值研究[J].海峡药学,2018,30(1):134-155.
[14]徐正会.腹腔镜术联合醋酸曲普瑞林治疗子宫内膜异位症的临床效果观察[J].大家健康:学术版,2016,10(14):195.
[15]王琴,赵玲军.腹腔镜手术联合药物治疗子宫内膜异位症的疗效对比观察[J].中华全科医学,2014,12(10):1619-1621.
[16]王嵩,宋殿荣.血小板及相关因子功能的异常与子宫内膜异位症发病机制的关系[J].国际妇产科学杂志,2018,45(3):279-283.
[17]Mao GH,Feng Z,He Y,et al.Experimental research:comparisons of the effects of long-acting and short-acting Gn RH agonists on embryo quality,endometrial thickness and pregnancy rate in human in vitro fertilization[J].Arch Med Sci,2014,10(1):161-169.
[18]叶海琼,鲁照明,傅晓冬,等.腹腔镜保守手术联合达菲林治疗育龄期卵巢型子宫内膜异位症的疗效观察[J].西部医学,2016,28(10):1423-1427.
[19]Barbieri M,Somigliana E,Oneda S,et al.Decidualized ovarian endometriosis in pregnancy:a challenging diagnostic entity[J].Hum Reprod,2009,24(8):1818-1824.
[20]冯艳,卢秀琴.VEGF、Ang-2和IL-1β在子宫内膜异位症中的表达[J].山西医科大学学报,2014,45(10):961-963.
[2]覃正文.腹腔镜联合亮丙瑞林治疗子宫内膜异位症伴不孕的价值分析及对患者生育能力的影响[J].中国妇幼保健,2017,32(1):113-115.
[3]Granese R,Perino A,Calagna G,et al.Gonadotrophin-releasinghormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis:a multi-center randomized trial[J].Acta Obstet Gynecol Scand,2015,94(6):637-645.
[4]赵晋,李红霞,顾蓓.子宫内膜异位症术后达菲林与达那唑辅助治疗的临床观察[J].实用临床医药杂志,2012,11(5):348-349.
[5]赵淑芬,曹华.腹腔镜术联合达菲林治疗子宫内膜异位症的临床疗效及对患者血清IL-6、Syndecan-1表达的影响[J].中国妇幼保健,2018,33(12):2663-2666.
[6]王丹,李怀芳.达菲林联合腹腔镜术治疗子宫内膜异位症对VEGF,Ang-2和Tie-2水平的影响[J].中国妇幼健康研究,2016,27(8):994-997.
[7]许希中.子宫内膜异位症伴不孕患者腹腔镜术后不同治疗方法对妊娠率的影响[J].重庆医学,2014,43(5):611-612,627.
[8]张瑞霞,刘增娟,谢伟,等.腹腔镜诊断盆腔子宫内膜异位症及对不孕症患者的疗效观察[J].中国计划生育和妇产科,2012,4(2):41-45.
[9]贾慧娟,胡玉玲,裴俊利,等.腹腔镜下子宫内膜异位症术后不同处理方法的临床疗效比较[J].疑难病杂志,2013,12(4):290-292.
[10]张丽萍.经腹部超声与经阴道超声诊断子宫内膜异位症的价值对比[J].临床医学研究与实践,2017,2(29):143-144.
[11]张媛,刘筱茂,霍艳宁,等.中药口服联合保留灌肠治疗子宫内膜异位症生存质量及疗效评价[J].环球中医药,2017,10(7):712-715.
[12]徐丽梅,郑志峰,毛俊涛,等.中医灸法护理干预在原发性痛经中的应用及对VAS评分的影响研究[J].实用妇科内分泌电子杂志,2017,4(9):50-51.
[13]严雪文,廖艳婷,尚雪.子宫内膜异位症术后应用达菲林的价值研究[J].海峡药学,2018,30(1):134-155.
[14]徐正会.腹腔镜术联合醋酸曲普瑞林治疗子宫内膜异位症的临床效果观察[J].大家健康:学术版,2016,10(14):195.
[15]王琴,赵玲军.腹腔镜手术联合药物治疗子宫内膜异位症的疗效对比观察[J].中华全科医学,2014,12(10):1619-1621.
[16]王嵩,宋殿荣.血小板及相关因子功能的异常与子宫内膜异位症发病机制的关系[J].国际妇产科学杂志,2018,45(3):279-283.
[17]Mao GH,Feng Z,He Y,et al.Experimental research:comparisons of the effects of long-acting and short-acting Gn RH agonists on embryo quality,endometrial thickness and pregnancy rate in human in vitro fertilization[J].Arch Med Sci,2014,10(1):161-169.
[18]叶海琼,鲁照明,傅晓冬,等.腹腔镜保守手术联合达菲林治疗育龄期卵巢型子宫内膜异位症的疗效观察[J].西部医学,2016,28(10):1423-1427.
[19]Barbieri M,Somigliana E,Oneda S,et al.Decidualized ovarian endometriosis in pregnancy:a challenging diagnostic entity[J].Hum Reprod,2009,24(8):1818-1824.
[20]冯艳,卢秀琴.VEGF、Ang-2和IL-1β在子宫内膜异位症中的表达[J].山西医科大学学报,2014,45(10):961-963.