CAJ | 학술논문

【目的】探讨腹腔镜手术联合促性腺激素释放激素激动剂（GnRH-a）治疗中、重度子宫内膜异位症（内异症）的临床疗效。【方法】回顾性分析湖南省人民医院2010年3月至2013年3月收治的50例内异症患者临床资料。根据手术前后联合使用GnRH-a情况分为A和B两组。术前术后联合治疗组（A组）：15例，腹腔镜手术前皮下注射GnRH-a共2～3次，术后再注射3次；术后联合治疗组（B组）：35例，腹腔镜手术后皮下注射GnRH-a共3-6次。术后所有患者随访12个月。比较两组患者的手术时间、术中出血量、术后恢复情况、疼痛症状视觉模拟评分（VAS）、复发率及药物不良反应等指标。【结果】A组与B组手术时间分别为（65±12）min、（92±16）min；术中出血量分别为（105±12）mL、（190±29）mL ；A组患者术后下床活动时间及肛门排气时间均早于B组；治疗后随访至术后12个月，A组和B组VAS分别由术前3．7（1．7～6．5）分、3．2（1．4～6．4）分下降至1．6（1．0～3．6）分、1．6（1．1～3．5）分，A组和B组患者随访期间复发率分别为7％（1/15）、6％（2/35），两治疗组之间比较无统计学意义。【结论】腹腔镜手术联合术前术后使用GnRH-a治疗中、重度内异症能够缩短手术时间、减少术中失血、促进术后恢复；但是，与术后联合使用GnRH-a在改善术后痛经、降低复发率方面效果相当。
【목적】탐토복강경수술연합촉성선격소석방격소격동제（GnRH-a）치료중、중도자궁내막이위증（내이증）적림상료효。【방법】회고성분석호남성인민의원2010년3월지2013년3월수치적50례내이증환자림상자료。근거수술전후연합사용GnRH-a정황분위A화B량조。술전술후연합치료조（A조）：15례，복강경수술전피하주사GnRH-a공2～3차，술후재주사3차；술후연합치료조（B조）：35례，복강경수술후피하주사GnRH-a공3-6차。술후소유환자수방12개월。비교량조환자적수술시간、술중출혈량、술후회복정황、동통증상시각모의평분（VAS）、복발솔급약물불량반응등지표。【결과】A조여B조수술시간분별위（65±12）min、（92±16）min；술중출혈량분별위（105±12）mL、（190±29）mL ；A조환자술후하상활동시간급항문배기시간균조우B조；치료후수방지술후12개월，A조화B조VAS분별유술전3．7（1．7～6．5）분、3．2（1．4～6．4）분하강지1．6（1．0～3．6）분、1．6（1．1～3．5）분，A조화B조환자수방기간복발솔분별위7％（1/15）、6％（2/35），량치료조지간비교무통계학의의。【결론】복강경수술연합술전술후사용GnRH-a치료중、중도내이증능구축단수술시간、감소술중실혈、촉진술후회복；단시，여술후연합사용GnRH-a재개선술후통경、강저복발솔방면효과상당。
To explore clinical efficacy of laparoscopy combined with gonadotropin-releasing hormone agonists (GnRH-a) for the treatment of moderate or severe endometriosis .[Methods]Clinical data of 50 patients with endometriosis in Hunan provincial people's hospital from Mar .2010 to March 2013 were analyzed retrospectively .According to the treatment methods ,all patients were divided into group A and group B .Preoperative combined with postoperative treatment group (group A ,n=15) was given subcutaneous injection with GnRH-a for 2~3 times before laparoscopy and re-injection for 3 times after laparoscopy .Postoperative treatment group(group B ,n =35) was given subcutaneous injection with GnRH-a for 3~6 times after laparoscopy .All patients were followed up for 12 months after operation .Operation time ,intraoperative blood loss ,post-operative recovery ,pain symptom visual analog scale (VAS ) ,recurrence and adverse reaction were compared between two groups .[Results] The operation time in group A and group B were (65 ± 12)min and (92 ± 16)min ,respectively .The amount of bleeding in group A and group B were (105 ± 12)mL and (190 ± 29)ml ,respectively .The time of out-of-bed activity and anus exhaust time in group A after operation were earlier than those in group B .The VAS scores in group A and group B at 12-month follow up after operation were decreased from preoperative 3 .7(1 .7~6 .5) and 3 .2(1 .4~6 .4) points to 1 .6(1 .0~3 .6) and 1 .6(1 .1~3 .5) points ,respectively .The recurrence rates in group A and group during follow up were 7% (1/15) and 6%(2/35) ,respectively .There was no significant difference between two groups .[Conclusion] Laparoscopy combined with pre-operative and postoperative GnRH-a therapy for the treatment of moderate or severe endometriosis can shorten the operation time ,decrease intraoperative blood loss and promote postoperative recovery .However ,laparoscopy combined with preopera-tive and postoperative GnRH-a therapy has the same efficacy in improving postoperative pain and reducing the recurrence rate as the postoperative GnRH-a therapy .