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目的探讨腹腔镜联合药物治疗Ⅲ期、Ⅳ期子宫内膜异位症的临床价值。方法选取2011年11月-2014年12月在该院经腹腔镜手术确诊并治疗的Ⅲ期、Ⅳ期子宫内膜异位症患者68例,随机分为A、B、C组。A组(24例)术后第5天开始肌肉注射曲普瑞林第1针,以后每隔28 d肌肉注射1次,共6次。B组(22例)术后第5天开始肌肉注射曲普瑞林第1针,以后每隔42 d肌肉注射1次,共4次。C组(22例)术后第5天开始口服达那唑0.2 g/次,2次/d,共6个月。所有患者随访12个月,观察疗效。结果 A、B、C组有效率分别为87.50%、90.90%、86.36%;复发率分别为14.29%、10.00%、10.53%;妊娠率分别为37.50%、31.82%、36.36%。3组比较差异无统计学意义(P>0.05)。3组患者均出现药物不良反应,但不良反应的类型有所区别。肝损率分别为4.17%、0.00%、27.27%;体重增加率分别为8.33%、4.54%、63.64%,低雌激素率分别为79.17%、68.18%、4.54%,差异有统计学意义(P<0.05)。结论腹腔镜联合曲普瑞林治疗Ⅲ期、Ⅳ期子宫内膜异位症疗效确切,能降低复发率,提高妊娠率。尤其间隔42 d肌肉注射用药方便,不良反应相对低,且更为经济,有助于提高患者耐受性和依从性。
Objective To investigate the clinical value of laparoscopic combined with drug treatment of stage Ⅲ and Ⅳ endometriosis. Methods 68 patients with stage Ⅲ and Ⅳ endometriosis diagnosed and treated by laparoscopic surgery from November 2011 to December 2014 in our hospital were randomly divided into A, B and C groups. Group A (24 cases) started the first injection of triptorelin intramuscularly on the fifth day after the operation, and intramuscularly once every 28 days for 6 times. Group B (n = 22) started intramuscular injection of triptorelin on the fifth postoperative day, and then intramuscularly once every 42 days for 4 times. In group C (n = 22), danazol was administered 0.2 g once daily for 6 months after operation. All patients were followed up for 12 months to observe the curative effect. Results The effective rates of group A, B and C were 87.50%, 90.90% and 86.36% respectively. The recurrence rates were 14.29%, 10.00% and 10.53% respectively. The pregnancy rates were 37.50%, 31.82% and 36.36% respectively. There was no significant difference between the three groups (P> 0.05). Adverse drug reactions occurred in all three groups, but the types of adverse reactions were different. The rates of liver damage were 4.17%, 0.00% and 27.27% respectively. The body weight gain rates were 8.33%, 4.54% and 63.64%, respectively. The rates of low estrogen were 79.17%, 68.18% and 4.54%, respectively <0.05). Conclusion Laparoscopy combined with triptorelin treatment of stage Ⅲ, Ⅳ endometriosis exact effect, can reduce the recurrence rate and improve the pregnancy rate. In particular, intramuscular administration is convenient at 42-day intervals with relatively low adverse reactions and is more economical and helps to increase patient tolerance and adherence.