促性腺激素释放激素激动剂对子宫内膜异位症腹腔镜手术患者复发率及妊娠率的影响
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摘要
目的:观察促性腺激素释放激素激动剂(GnRH-a)对子宫内膜异位症腹腔镜手术患者复发率及妊娠率的影响。方法:选取2015年9月-2016年10月于本院进行子宫内膜异位症腹腔镜手术的98例患者作为研究对象,按照随机数字表法分为对照组和观察组,每组49例。对照组采用孕三烯酮治疗,观察组采用GnRH-a治疗。比较治疗前后两组雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)等生殖激素水平,和活性氧(ROS)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平,统计复查期间两组疼痛缓解率、复发率及妊娠率。结果:治疗后观察组生殖激素水平均低于对照组(P<0.05),治疗后观察组ROS、MDA水平均低于对照组(P<0.05),SOD水平高于对照组(P<0.05)。观察组疼痛缓解率为89.80%,大于对照组的51.02%(P<0.05);观察组复发率为8.16%,低于对照组的24.49%(P<0.05);观察组妊娠率为34.69%,高于对照组的12.24%(P<0.05)。结论:GnRH-a能降低子宫内膜异位症腹腔镜手术患者复发率,提高妊娠率,增强手术治疗效果。
Objective:To observe the effect of Gonadotropin Releasing Hormone Agonist(GnRH-a)on the recurrence rate and pregnancy rate of patients with endometriosis undergoing laparoscopic surgery.Method:A total of 98 patients with endometriosis who underwent laparoscopic surgery in our hospital from September2015 to October 2016 were selected as the study objects.The patients were divided into the control group and the observation group by random number table method,49 cases in each group.The control group was treated with Gestrinone and the observation group was treated with GnRH-a.The levels of reproductive hormones such as estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),reactive oxygen species(ROS),malondialdehyde(MDA)and superoxide dismutase(SOD)were compared before and after treatment of two groups.The pain relief rate,recurrence rate and pregnancy rate of two groups were recorded during the review period.Result:The levels of reproductive hormones in the observation group after treatment were lower than those in the control group(P<0.05).The ROS and MDA levels in the observation group after treatment were lower than those in the control group,and SOD level was higher than that in the control group,there were statistical significances(P<0.05).The pain relief rate of the observation group was 89.80%,it was higher than 51.02% of the control group(P<0.05),the recurrence rate of the observation group was 8.16%,it was lower than 24.49%of the control group(P<0.05),and the pregnancy rate of the observation group was 34.69%,it was higher than12.24% of the control group(P<0.05).Conclusion:GnRH-a can reduce the recurrence rate of endometriosis and increase the pregnancy rate in laparoscopic surgery,and enhance the surgical treatment effect.
Objective:To observe the effect of Gonadotropin Releasing Hormone Agonist(GnRH-a)on the recurrence rate and pregnancy rate of patients with endometriosis undergoing laparoscopic surgery.Method:A total of 98 patients with endometriosis who underwent laparoscopic surgery in our hospital from September2015 to October 2016 were selected as the study objects.The patients were divided into the control group and the observation group by random number table method,49 cases in each group.The control group was treated with Gestrinone and the observation group was treated with GnRH-a.The levels of reproductive hormones such as estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),reactive oxygen species(ROS),malondialdehyde(MDA)and superoxide dismutase(SOD)were compared before and after treatment of two groups.The pain relief rate,recurrence rate and pregnancy rate of two groups were recorded during the review period.Result:The levels of reproductive hormones in the observation group after treatment were lower than those in the control group(P<0.05).The ROS and MDA levels in the observation group after treatment were lower than those in the control group,and SOD level was higher than that in the control group,there were statistical significances(P<0.05).The pain relief rate of the observation group was 89.80%,it was higher than 51.02% of the control group(P<0.05),the recurrence rate of the observation group was 8.16%,it was lower than 24.49%of the control group(P<0.05),and the pregnancy rate of the observation group was 34.69%,it was higher than12.24% of the control group(P<0.05).Conclusion:GnRH-a can reduce the recurrence rate of endometriosis and increase the pregnancy rate in laparoscopic surgery,and enhance the surgical treatment effect.
引文
[1]郎景和,冷金花,王泽华,等.促性腺激素释放激素激动剂在子宫内膜异位症和子宫平滑肌瘤治疗中的应用专家意见[J].中华妇产科杂志,2017,52(2):77-81.
[2]方淑芬,万玉珍.子宫内膜异位症合并不孕的患者经过腹腔镜手术后自然妊娠与妊娠结局的影响因素[J].中国医学创新,2018,15(29):5-9.
[3]胡茜,刘兴琼,魏璐,等.腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效观察[J].现代生物医学进展,2016,16(25):4899-4901.
[4]陈曼诗,陈春莹,付艳霞,等.腹腔镜治疗子宫内膜异位症合并不孕患者术后辅助药物治疗对受孕和妊娠影响[J].中国医学创新,2018,15(20):133-136.
[5]张斌,王鲁梅,韦励,等.腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症的临床效果[J].中国生育健康杂志,2016,27(3):251-252.
[6]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.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002.
[8]陈帆,杨华娣.腹腔镜手术联合促性腺激素释放激素激动剂对子宫内膜异位症不孕的临床疗效研究[J].中国内镜杂志,2016,22(9):71-74.
[9]陈艳,闻静.腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症的疗效观察[J].中国妇幼保健,2017,32(21):5282-5284.
[10]黄俊花,刘明星,陈晓红,等.不同临床病理类型子宫内膜异位症合并不孕患者生育力的研究[J].中国微创外科杂志,2017,17(7):594-598.
[11]潘伟,俞磊.促性腺激素释放激素激动剂联合孕三烯酮在子宫内膜异位症腹腔镜术后的临床应用[J].中国临床研究,2016,29(4):549-551.
[12]杜惠,张文静,张文静,等.促性腺激素释放激素激动剂超长方案提高中重度子宫内膜异位症患者辅助生殖技术妊娠率[J].第二军医大学学报,2017,38(7):852-856.
[13]范淑静,李爱明,谢彩霞.子宫内膜异位症生育指数预测促性腺激素释放激素激动剂治疗子宫内膜异位症效果的价值探讨[J].中国性科学,2016,25(9):38-40.
[14]Bedaiwy M A,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].Fertil Steril,2017,107(3):537-548.
[15]张纯溪,岳慧敏,张萍,等.促性腺激素释放激素激动剂与左炔诺孕酮宫内节育器联合治疗子宫内膜不典型增生的临床疗效研究[J].中国计划生育和妇产科,2016,8(6):56-58.
[16]陈爱平,蔡长争,陈丽花,等.促性腺激素释放激素激动剂对子宫内膜异位症腹腔镜术后患者症状缓解率及复发率的影响[J].中国计划生育和妇产科,2017,9(12):53-56.
[17]黄志欣,李隽,黄博,等.腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效观察[J].现代生物医学进展,2017,17(1):70-72.
[18]Shen L F,Ma C L,Ji F,et al.Effect of combined therapy GnRH-a plus add-back tibolone on endocrine hormone levels and bone loss in endometriosis patients[J].Biomedical Research,2017,28(11):4787-4791.
[19]张岩,杨飚,徐文萍,等.促性腺激素释放激素激动剂联合左炔诺孕酮宫内节育系统用于子宫内膜异位症术后效果[J].中国临床保健杂志,2016,19(4):389-392.
[20]Zhu S N,Zhu Y J,Liu Y B,et al.Comparison of Outcomes of Different Postoperative Hormone Therapy in the Treatment of Ovarian Endometriosis:A Brief Report[J].Adv Ther,2018,35(6):857-863.
[21]陈丹,张辉.促性腺激素释放激素激动剂对深部浸润型子宫内膜异位症患者生育功能的影响[J].中国妇幼保健,2018,33(1):145-147.
[2]方淑芬,万玉珍.子宫内膜异位症合并不孕的患者经过腹腔镜手术后自然妊娠与妊娠结局的影响因素[J].中国医学创新,2018,15(29):5-9.
[3]胡茜,刘兴琼,魏璐,等.腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效观察[J].现代生物医学进展,2016,16(25):4899-4901.
[4]陈曼诗,陈春莹,付艳霞,等.腹腔镜治疗子宫内膜异位症合并不孕患者术后辅助药物治疗对受孕和妊娠影响[J].中国医学创新,2018,15(20):133-136.
[5]张斌,王鲁梅,韦励,等.腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症的临床效果[J].中国生育健康杂志,2016,27(3):251-252.
[6]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.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002.
[8]陈帆,杨华娣.腹腔镜手术联合促性腺激素释放激素激动剂对子宫内膜异位症不孕的临床疗效研究[J].中国内镜杂志,2016,22(9):71-74.
[9]陈艳,闻静.腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症的疗效观察[J].中国妇幼保健,2017,32(21):5282-5284.
[10]黄俊花,刘明星,陈晓红,等.不同临床病理类型子宫内膜异位症合并不孕患者生育力的研究[J].中国微创外科杂志,2017,17(7):594-598.
[11]潘伟,俞磊.促性腺激素释放激素激动剂联合孕三烯酮在子宫内膜异位症腹腔镜术后的临床应用[J].中国临床研究,2016,29(4):549-551.
[12]杜惠,张文静,张文静,等.促性腺激素释放激素激动剂超长方案提高中重度子宫内膜异位症患者辅助生殖技术妊娠率[J].第二军医大学学报,2017,38(7):852-856.
[13]范淑静,李爱明,谢彩霞.子宫内膜异位症生育指数预测促性腺激素释放激素激动剂治疗子宫内膜异位症效果的价值探讨[J].中国性科学,2016,25(9):38-40.
[14]Bedaiwy M A,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].Fertil Steril,2017,107(3):537-548.
[15]张纯溪,岳慧敏,张萍,等.促性腺激素释放激素激动剂与左炔诺孕酮宫内节育器联合治疗子宫内膜不典型增生的临床疗效研究[J].中国计划生育和妇产科,2016,8(6):56-58.
[16]陈爱平,蔡长争,陈丽花,等.促性腺激素释放激素激动剂对子宫内膜异位症腹腔镜术后患者症状缓解率及复发率的影响[J].中国计划生育和妇产科,2017,9(12):53-56.
[17]黄志欣,李隽,黄博,等.腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效观察[J].现代生物医学进展,2017,17(1):70-72.
[18]Shen L F,Ma C L,Ji F,et al.Effect of combined therapy GnRH-a plus add-back tibolone on endocrine hormone levels and bone loss in endometriosis patients[J].Biomedical Research,2017,28(11):4787-4791.
[19]张岩,杨飚,徐文萍,等.促性腺激素释放激素激动剂联合左炔诺孕酮宫内节育系统用于子宫内膜异位症术后效果[J].中国临床保健杂志,2016,19(4):389-392.
[20]Zhu S N,Zhu Y J,Liu Y B,et al.Comparison of Outcomes of Different Postoperative Hormone Therapy in the Treatment of Ovarian Endometriosis:A Brief Report[J].Adv Ther,2018,35(6):857-863.
[21]陈丹,张辉.促性腺激素释放激素激动剂对深部浸润型子宫内膜异位症患者生育功能的影响[J].中国妇幼保健,2018,33(1):145-147.