曲普瑞林注射剂联合来曲唑辅助手术治疗子宫内膜异位症的临床效果
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摘要
目的探讨曲普瑞林注射剂联合来曲唑辅助手术治疗子宫内膜异位症的临床效果。方法将我院2016年6月至2017年6月收治的80例子宫内膜异位症患者随机分为观察组和对照组,各40例。两组患者均行保留生育功能的腹腔镜手术。对照组于术后月经来潮第1天肌肉注射曲普瑞林;观察组在对照组治疗基础上,于术后第5天开始口服来曲唑片。两组均连续治疗6个月。比较两组的临床疗效、妊娠率、治疗前、后血清CA125、CA199、EMAb水平及不良反应发生情况。结果观察组的治疗总有效率为95.00%,显著高于对照组的75.00%(P<0.05);观察组的妊娠率为57.50%,显著高于对照组的30.00%(P<0.05);治疗后,两组患者血清CA125、CA199及EMAb水平均显著降低,且观察组明显低于对照组(P<0.05)。结论子宫内膜异位症患者术后采用曲普瑞林注射剂联合来曲唑进行巩固治疗,临床效果较好,其作用机制可能与降低血清CA125、CA199和EMAb水平有关,且安全性较高,值得临床推广和应用。
Objective To investigate the clinical effect of triptorelin injection combined with letrozole assisted surgery in the treatment of endometriosis. Methods Eighty patients with endometriosis admitted in our hospital from June 2016 to June2017 were randomly divided into observation group and control group, with 40 cases of each group. Patients in both groups underwent laparoscopic surgery with fertility preservation. The control group received intramuscular injection of tripraline on the first day of postoperative menstruation. On the basis of treatment in the control group, the observation group began to take letrozole tablets orally on the 5 th day after surgery. Both groups were treated continuously for 6 months. The clinical efficacy, pregnancy rate, serum CA125, CA199 and EMAb levels before and after treatment and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 95.00%, which was significantly higher than 75.00% in the control group(P <0.05). The pregnancy rate of the observation group was57.50%, which was significantly higher than 30.00% in the control group(P<0.05). After treatment, serum CA125, CA199 and EMAb levels in the two groups significantly reduced, and those in the observation group were significantly lower than the control group(P <0.05). Conclusion The clinical effect of triptorelin combined with letrozole assisted surgery in the treatment of endometriosis is good, and the mechanism may be related to lowering serum CA125, CA199 and EMAb levels,which is safty and worthy of clinical promotion and application.
Objective To investigate the clinical effect of triptorelin injection combined with letrozole assisted surgery in the treatment of endometriosis. Methods Eighty patients with endometriosis admitted in our hospital from June 2016 to June2017 were randomly divided into observation group and control group, with 40 cases of each group. Patients in both groups underwent laparoscopic surgery with fertility preservation. The control group received intramuscular injection of tripraline on the first day of postoperative menstruation. On the basis of treatment in the control group, the observation group began to take letrozole tablets orally on the 5 th day after surgery. Both groups were treated continuously for 6 months. The clinical efficacy, pregnancy rate, serum CA125, CA199 and EMAb levels before and after treatment and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 95.00%, which was significantly higher than 75.00% in the control group(P <0.05). The pregnancy rate of the observation group was57.50%, which was significantly higher than 30.00% in the control group(P<0.05). After treatment, serum CA125, CA199 and EMAb levels in the two groups significantly reduced, and those in the observation group were significantly lower than the control group(P <0.05). Conclusion The clinical effect of triptorelin combined with letrozole assisted surgery in the treatment of endometriosis is good, and the mechanism may be related to lowering serum CA125, CA199 and EMAb levels,which is safty and worthy of clinical promotion and application.
引文
[1]何晔,魏兆莲.子宫内膜异位症的治疗新进展[J].国际生殖健康/计划生育杂志,2015,34(3):255-259.
[2]陈灿,王冰,陈衡.子宫内膜异位症诊断与治疗进展[J].中华实用诊断与治疗杂志,2014,28(2):114-115.
[3]詹润芳.GnRH-a联合腹腔镜保守性手术治疗Ⅲ~Ⅳ期子宫内膜异位症的疗效及复发因素分析[J].医学临床研究,2016,33(2):238-241.
[4]陈凤群.来曲唑、HMG、曲普瑞林联合促排卵治疗多囊卵巢综合征不孕患者的疗效观察[J].河北医药,2015,37(6):900-901.
[5]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[6]杨建敏.曲普瑞林注射剂联合孕三烯酮胶囊治疗子宫内膜异位症的临床研究[J].中国临床药理学杂志,2018,34(3):257-259.
[7]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[8]冷金花,郎景和.子宫内膜异位症恶变的研究进展[J].中国妇产科临床杂志,2016,21(6):494-495.
[9]郑兆秋.子宫内膜异位症的临床表现特点及其相关因素[J].中国中医药现代远程教育,2010,8(19):76.
[10]VERCELLINI P,SOMIGLIANA E,VIGAN P,et al.Endometriosis:current therapies and new pharmacological developments[J].Drugs,2016,69(6):649.
[11]李灵香.子宫内膜异位症的发病原因及临床症状分析[J].中国妇幼保健,2017,32(14):3177-3179.
[12]CASPER RF.Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills[J].Fertil Steril,2017,107(3):533-536.
[13]CENTINI G,AFORS K,MURTADA R,et al.The impact of laparoscopic surgical management of deep endometriosis on pregnancy rate[J].J Minim Invasive Gynecol,2016,23(1):113-119.
[14]王菲菲,齐歆.子宫内膜异位症术后应用曲普瑞林治疗的效果与护理[J].中华现代护理杂志,2013,48(36):4482-4485.
[15]李双梅,邵华江,马建婷.芳香化酶与子宫内膜异位症[J].中国实用妇科与产科杂志,2012,28(1):70-72.
[16]俞楚仪,刘佳,李娟,等.来曲唑应用于多囊卵巢综合征促排卵治疗的研究进展[J].国际生殖健康/计划生育杂志,2017,36(2):146-149.
[17]辛玲丽,侯庆香,高原,等.来曲唑联合炔诺酮治疗子宫内膜异位症的疗效分析[J].中国生育健康杂志,2016,27(1):54-56.
[18]张爱云,康佳丽,何谦谊,等.子宫内膜异位症患者血清CA125及EMAb的临床评价[J].实用医学杂志,2004,20(7):750-751.
[19]ERSOY GS,ZOLBIN MM,COSAR E,et al.GnRH analog and letrozole inhibit stem cell recruitment to endometriosis[J].Fertil Steril,2016,106(3):268.
[2]陈灿,王冰,陈衡.子宫内膜异位症诊断与治疗进展[J].中华实用诊断与治疗杂志,2014,28(2):114-115.
[3]詹润芳.GnRH-a联合腹腔镜保守性手术治疗Ⅲ~Ⅳ期子宫内膜异位症的疗效及复发因素分析[J].医学临床研究,2016,33(2):238-241.
[4]陈凤群.来曲唑、HMG、曲普瑞林联合促排卵治疗多囊卵巢综合征不孕患者的疗效观察[J].河北医药,2015,37(6):900-901.
[5]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[J].中华妇产科杂志,2015,50(3):161-169.
[6]杨建敏.曲普瑞林注射剂联合孕三烯酮胶囊治疗子宫内膜异位症的临床研究[J].中国临床药理学杂志,2018,34(3):257-259.
[7]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[8]冷金花,郎景和.子宫内膜异位症恶变的研究进展[J].中国妇产科临床杂志,2016,21(6):494-495.
[9]郑兆秋.子宫内膜异位症的临床表现特点及其相关因素[J].中国中医药现代远程教育,2010,8(19):76.
[10]VERCELLINI P,SOMIGLIANA E,VIGAN P,et al.Endometriosis:current therapies and new pharmacological developments[J].Drugs,2016,69(6):649.
[11]李灵香.子宫内膜异位症的发病原因及临床症状分析[J].中国妇幼保健,2017,32(14):3177-3179.
[12]CASPER RF.Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills[J].Fertil Steril,2017,107(3):533-536.
[13]CENTINI G,AFORS K,MURTADA R,et al.The impact of laparoscopic surgical management of deep endometriosis on pregnancy rate[J].J Minim Invasive Gynecol,2016,23(1):113-119.
[14]王菲菲,齐歆.子宫内膜异位症术后应用曲普瑞林治疗的效果与护理[J].中华现代护理杂志,2013,48(36):4482-4485.
[15]李双梅,邵华江,马建婷.芳香化酶与子宫内膜异位症[J].中国实用妇科与产科杂志,2012,28(1):70-72.
[16]俞楚仪,刘佳,李娟,等.来曲唑应用于多囊卵巢综合征促排卵治疗的研究进展[J].国际生殖健康/计划生育杂志,2017,36(2):146-149.
[17]辛玲丽,侯庆香,高原,等.来曲唑联合炔诺酮治疗子宫内膜异位症的疗效分析[J].中国生育健康杂志,2016,27(1):54-56.
[18]张爱云,康佳丽,何谦谊,等.子宫内膜异位症患者血清CA125及EMAb的临床评价[J].实用医学杂志,2004,20(7):750-751.
[19]ERSOY GS,ZOLBIN MM,COSAR E,et al.GnRH analog and letrozole inhibit stem cell recruitment to endometriosis[J].Fertil Steril,2016,106(3):268.