不同剂量米非司酮联合当归四逆汤在子宫内膜异位症术后治疗中的应用
摘要
目的观察盆腔子宫内膜异位症保守或半保守手术后患者服用不同剂量米非司酮联合中药当归四逆汤的临床疗效及不良反应。方法将180例子宫内膜异位症患者分为6组:分别为G1(5 mg米非司酮联合当归四逆汤组)、G2(10 mg米非司酮联合当归四逆汤组)、G3(5 mg米非司酮组)、G4(10 mg米非司酮组)和D1(孕三烯酮组)、D2(空白组)组,均于手术后5 d内开始用药,疗程6个月。比较应用不同方法治疗子宫内膜异位症术后的疗效、不良反应情况。结果各组患者疼痛症状都得到不同程度缓解,G1、G2、G3、G4与D1组完全缓解率分别为89.7%、90.0%、83.3%、86.7%和75.9%,明显高于D2组的53.3%,差异有统计学意义(P<0.05)。G1、G2、G3、G4、D1组复发率分别为3.4%、3.3%、6.7%、3.3%和6.9%,显著低于D2组的26.7%(P<0.05)。G1、G2、G3、G4与D1组之间的完全缓解率差异无统计学意义(P>0.05),G2、G4、D1组用药后雌激素(E2)均有明显减少(P<0.05),G1、G3组用药后E2及其余性激素水平无显著变化(P>0.05)。各组均于术后6个月复查血清CA125,均已下降至35 IU/mL以下,与用药前比较显著下降(P<0.05)。复发病例CA125为(46.7±11)IU/mL,与未复发病例CA125值(26.7±9)IU/mL比较差异有统计学意义(P<0.05)。结论使用低剂量米非司酮联合中药四逆汤治疗子宫内膜异位症,疗效显著,不良反应未见增多,价格低廉。血清CA125证实对检测临床治疗效果是有价值的,并可作为是否复发的监测指标。
引文
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[15]AMARAL V F,FERRIANI R A,SA M F,et al.Positive correla-tion between serum and peritoneal fluid CA-125 levels in womenwith pelvic endometriosis[J].Sao Paulo Med J,2006,124(4):223-227.
[16]FEDELE L.Serum CA125:measurements in the diagnosis of endome-triosis recurrence[J].Obstet Gynecol,1988,72(1):19-22.
[17]NAGAMANI M.CA 125 levels in momtofing therapy for endome-triosis and in prediction of recurrence[J].Int J Fertil,1992,37(4):227-231.
(19):2589-2591.
[2]KONDO W,BOURDEL N,TAMBURRO S,et al.Complicationsafter surgery for deeply infiltrating pelvic endometriosis[J].BJOG,2011,118(3):292-298.
[3]PORPORA M G,PALLANTE D,FERRO A,et al.Pain andovarian endometrioma recurrence after laparoscopic treatment of en-dometriosis:a long-term prospective study[J].Fertil Steril,2010,93(3):716-721.
[4]BERLANDA N,VERCELLINI P,FEDELE L.The outcomes ofrepeat surgery for recurrent symptomatic endometriosis[J].CurrOpin Obstet Gynecol,2010,22(4):320-325.
[5]TANMAHASAMUT P,RATTANACHAIYANONT M,ANGSU-WATHANA S,et al.Postoperative levonorgestrel-releasing intraute-rine system for pelvic endometriosis-related pain:a randomized con-trolled trial[J].Obstet Gynecol,2012,119(3):519-526.
[6]KAWANO Y,NASU K,LI H,et al.Application of the histonedeacetylase inhibitors for the treatment of endometriosis:histonemodifications as pathogenesis and novel therapeutic target[J].Hum Reprod,2011,26(9):2486-2498.
[7]王洪兰.子宫内膜异位症治疗现状及进展[J].中国城乡企业卫生,2008,8(4):87-89.
[8]沈旸,谈勇.子宫内膜异位症的中医药治疗概况[J].中华实用中西医杂志,2008,21(21):1648-1649.
[9]ZHU X,HAMILTON K D,MCNICOL E D.Acupuncture for painin endometriosis[J].Cochrane Database Syst Rev,2011(9):CD007864.
[10]FLOWER A,LIU J P,CHEN S,et al.Chinese herbal medicinefor endometriosis[J].Cochrane Database Syst Rev,2009,3:CD006568.
[11]BOUCHARD P,CHABBERT BUFFET N,FAUSER B C.Selec-tive progesterone receptor modulators in reproductive medicine:pharmacology,clinical efficacy and safety[J].Fertil Steril,2011,96(5):1175-1189.
[12]薛莉.当归四逆汤加减治疗子宫内膜异位症40例观察[J].实用中医药杂志,2009,25(9):592.
[13]卢丽芳.当归四逆汤治疗慢性盆腔痛48例[J].陕西中医,2011,32(3):274-275.
[14]SOCOLOV R,BUTUREANU S,ANGIONI S,et al.The value ofserological markers in the diagnosis and prognosis of endometriosis:a prospective case-control study[J].Eur J Obstet Gynecol Re-prod Biol,2011,154(2):215-217.
[15]AMARAL V F,FERRIANI R A,SA M F,et al.Positive correla-tion between serum and peritoneal fluid CA-125 levels in womenwith pelvic endometriosis[J].Sao Paulo Med J,2006,124(4):223-227.
[16]FEDELE L.Serum CA125:measurements in the diagnosis of endome-triosis recurrence[J].Obstet Gynecol,1988,72(1):19-22.
[17]NAGAMANI M.CA 125 levels in momtofing therapy for endome-triosis and in prediction of recurrence[J].Int J Fertil,1992,37(4):227-231.