微创医学

目的观察腹腔镜联合促性腺激素释放激素激动剂(GnRH-a)治疗卵巢子宫内膜异位囊肿的临床疗效及安全性。方法将90例卵巢子宫内膜异位囊肿患者随机分为3组,A组30例,单纯行腹腔镜手术;B组30例,腹腔镜术后加用孕三烯酮(内美通)治疗;C组30例,腹腔镜术后加用GnRH-a剂(曲普瑞林)治疗。疗程均为3个月。术后随访2年,比较3组症状改善情况及术后复发率、痛经缓解率、妊娠率、药物不良反应之间的差异。结果 B组和C组的有效率及痛经缓解率均高于A组(P<0.05),C组的有效率高于B组,3组复发率分别为33.33%、19.23%、6.89%,C组副反应发生率显著低于B组(P<0.05),3组妊娠率比较,差异无统计学意义(P>0.05)。结论 GnRH-a用于卵巢子宫内膜异位囊肿腹腔镜术后辅助治疗,能提高有效率,降低复发率,且Gn-RH-a副反应发生率低,但其不能明显提高妊娠率。

Objective To observe the efficacy and safety of laparoscopy combined with gonadotropin-releasing hormone agonist(GnRH-a) in the treatment of ovarian endometriotic cysts.Methods 90 cases of ovarian endometriotic cysts were divided into 3 groups,group A:30 cases of laparoscopic surgery alone,group B: 30 patients with laparoscopic operation plus nemestran treatment,and group C:30 cases with laparoscopic surgery plus GnRH-a(goserelin) treatment,all with a course of 3 months.Patients were followed up for 2 years,and the differences in the improvement of symptoms,the recurrence rate,remission rate of dysmenorrhea,pregnancy,and adverse drug reactions of three groups were compared.Results The efficiency and ease dysmenorrheal rates were higher in group B and group C than in group A(P<0.05),with efficacy in group C higher than in group B.Recurrence rates of group A,B and C were 33.33%,19.23%,6.89%,respectively.Side effect rate of group C was significantly lower than that of group B(P<0.05).There was no significant difference in pregnancy rate in 3 groups(P>0.05).Conclusion GnRH-a as laparoscopic adjuvant therapy for ovarian endometriotic cysts can significantly improve the efficiency and reduce the recurrence rate with few side effect,it but could not improve pregnancy rate.