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目的:探讨腹腔镜术后米非司酮、促性腺激素释放激素激动剂、促性腺激素释放激素激动剂(GnRH-α)联合反向添加治疗子宫内膜异位症不同用药周期的各临床效果。方法:选择85例子宫内膜异位症合并不孕患者分为GnRH-α治疗A组21例,米非司酮治疗B组22例,GnRH-α联合反向添加治疗C组20例;未用药对照D组22例。此85例患者均在腹腔镜下行保守手术治疗。GnRH-a组于术后3～5天皮下注射曲普瑞林3.75 mg,每隔4周注射1次;GnRH-a联合反向添加组同GnRH-a组之外于注射第1支曲普瑞林同时口服戊酸雌二醇1mg及安宫黄体酮6 mg至治疗结束;米非司酮组术后口服米非司酮10mg,每日1次;未用药组术后不用药。结果:①3个月内疼痛评分各用药组均比对照组评分低,差异具有统计学意义(P<0.05),绝经期症状GnRH-α联合反向添加组症状评分较其他用药组低(P<0.05),各用药组均有不同程度的肝功能损伤,以米非司酮组较轻(P<0.05);②各治疗组治疗后患者血清卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)、抗子宫内膜抗体(EmAb)、CA125水平较未用药组均明显降低(P<0.05);③GnRH-α联合反向添加治疗3月后停药,之后3月内受孕率最高,高于其他各组(P<0.05),且绝经期症状无明显加重,肝功能损伤明显减轻。结论:腹腔镜保守手术治疗后应用GnRH-α联合反向添加治疗,短期疗法(此研究以3月为准)可有效提高子宫内膜异位症患者受孕率及疼痛缓解率,降低术后复发率,且不良反应相对较小。
Objective: To investigate the clinical effects of laparoscopic mifepristone, gonadotropin-releasing hormone agonist and gonadotropin-releasing hormone agonist (GnRH-α) in combination with reverse addition in different medication cycles of endometriosis . Methods: 85 cases of endometriosis with infertility were divided into GnRH-α group A treatment group 21 cases, mifepristone treatment group B 22 cases, GnRH-α plus reverse treatment group C 20 cases; Drug control group D 22 cases. All 85 patients underwent laparoscopic conservative surgery. In the GnRH-a group, triptorelin was injected subcutaneously into the GnRH-a group at 3 to 5 days postoperatively. The rabbits in the GnRH-a group were injected subcutaneously with 3.75 mg triptorelin once a week for 4 weeks. Ruilin at the same time oral administration of estradiol valerate 1mg and Andong progesterone 6mg to the end of treatment; mifepristone group after oral administration of mifepristone 10mg, 1 times a day; no medication group after surgery without medication. Results: ① The score of pain score in 3 months was lower than that in control group, with significant difference (P <0.05). Symptoms of menopausal symptoms GnRH-α combined with reverse addition group were lower than other groups (P < (P <0.05); ②The levels of serum FSH, LH in each treatment group were significantly lower than those in the mifepristone group (P <0.05) , Estrogen (E2), anti-endometrial antibody (EmAb) and CA125 levels were significantly lower than those in the untreated group (P <0.05). ③GnRH-α was administered for 3 months, The highest rate, higher than the other groups (P <0.05), and no significant increase in menopausal symptoms, liver function was significantly reduced. Conclusions: GnRH-α combined with reverse addition after laparoscopic conservative surgery, short-term therapy (this study in March) can effectively improve the pregnancy rate and pain relief rate of patients with endometriosis, reduce postoperative recurrence Rate, and the adverse reaction is relatively small.