中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
27期
3245-3247,3248
,共4页
宋飞銮%蔡安利%黄丁%夏秋霞%周晔%吕杰强
宋飛鑾%蔡安利%黃丁%夏鞦霞%週曄%呂傑彊
송비란%채안리%황정%하추하%주엽%려걸강
子宫内膜异位症%促性腺素释放激素%戈舍瑞林%曲普瑞林%去氧孕烯炔雌醇%疼痛
子宮內膜異位癥%促性腺素釋放激素%戈捨瑞林%麯普瑞林%去氧孕烯炔雌醇%疼痛
자궁내막이위증%촉성선소석방격소%과사서림%곡보서림%거양잉희결자순%동통
Endometriosis%Gonadotropin - releasing hormone%Goserelin%Triptorein%Desogestrel ethinylestradiol%Pain
目的：探讨促性腺激素释放激素激动剂（ GnRH-a）联合去氧孕烯炔雌醇（妈富隆）治疗重度子宫内膜异位症（ EM）的临床疗效。方法选取2009年1月-2012年5月我院收治的80例重度EM患者，均行腹腔镜保守性手术。将患者随机分为两组：对照组38例，术后单纯给予GnRH-a治疗；观察组42例，术后给予GnRH-a联合妈富隆治疗。随访观察1年，比较两组患者术前和术后1年内分泌激素〔卵泡刺激素（ FSH）、黄体生成素（ LH）、雌二醇（ E2）〕水平、围绝经期症状的严重程度（ Kupperman评分）及患者围绝经期症状的主观感受。结果术前两组患者FSH、LH、E2水平间无差异（P>0.05）；而术后均较本组术前下降（P<0.05），但术后两组患者上述指标间无差异（P>0.05）。术前两组患者潮热出汗评分，外阴、阴道不适评分，关节痛评分，Kupperman总分间无差异（P>0.05）；术后观察组外阴、阴道不适评分及Kupperman总分均低于对照组〔（1.1±1.0）分与（2.0±1.5）分，（9.0±1.2）分与（10.5±1.3）分，P<0.05〕，而两组潮热出汗、关节痛评分间无差异（ P>0.05）。术前两组患者痛经、慢性盆腔痛、性交痛评分及主观感受总分间无差异（ P>0.05）；术后观察组患者慢性盆腔痛评分、主观感受总分均低于对照组〔（0.20±0.32）分与（0.40±0.53）分，（2.53±1.21）分与（3.47±1.31）分，P<0.05〕，而两组痛经、性交痛评分间无差异（ P≥0.05）。结论妈富隆可减轻重度EM患者GnRH-a治疗后引起的低雌激素症状，并能有效缓解EM的疼痛症状。
目的：探討促性腺激素釋放激素激動劑（ GnRH-a）聯閤去氧孕烯炔雌醇（媽富隆）治療重度子宮內膜異位癥（ EM）的臨床療效。方法選取2009年1月-2012年5月我院收治的80例重度EM患者，均行腹腔鏡保守性手術。將患者隨機分為兩組：對照組38例，術後單純給予GnRH-a治療；觀察組42例，術後給予GnRH-a聯閤媽富隆治療。隨訪觀察1年，比較兩組患者術前和術後1年內分泌激素〔卵泡刺激素（ FSH）、黃體生成素（ LH）、雌二醇（ E2）〕水平、圍絕經期癥狀的嚴重程度（ Kupperman評分）及患者圍絕經期癥狀的主觀感受。結果術前兩組患者FSH、LH、E2水平間無差異（P>0.05）；而術後均較本組術前下降（P<0.05），但術後兩組患者上述指標間無差異（P>0.05）。術前兩組患者潮熱齣汗評分，外陰、陰道不適評分，關節痛評分，Kupperman總分間無差異（P>0.05）；術後觀察組外陰、陰道不適評分及Kupperman總分均低于對照組〔（1.1±1.0）分與（2.0±1.5）分，（9.0±1.2）分與（10.5±1.3）分，P<0.05〕，而兩組潮熱齣汗、關節痛評分間無差異（ P>0.05）。術前兩組患者痛經、慢性盆腔痛、性交痛評分及主觀感受總分間無差異（ P>0.05）；術後觀察組患者慢性盆腔痛評分、主觀感受總分均低于對照組〔（0.20±0.32）分與（0.40±0.53）分，（2.53±1.21）分與（3.47±1.31）分，P<0.05〕，而兩組痛經、性交痛評分間無差異（ P≥0.05）。結論媽富隆可減輕重度EM患者GnRH-a治療後引起的低雌激素癥狀，併能有效緩解EM的疼痛癥狀。
목적：탐토촉성선격소석방격소격동제（ GnRH-a）연합거양잉희결자순（마부륭）치료중도자궁내막이위증（ EM）적림상료효。방법선취2009년1월-2012년5월아원수치적80례중도EM환자，균행복강경보수성수술。장환자수궤분위량조：대조조38례，술후단순급여GnRH-a치료；관찰조42례，술후급여GnRH-a연합마부륭치료。수방관찰1년，비교량조환자술전화술후1년내분비격소〔란포자격소（ FSH）、황체생성소（ LH）、자이순（ E2）〕수평、위절경기증상적엄중정도（ Kupperman평분）급환자위절경기증상적주관감수。결과술전량조환자FSH、LH、E2수평간무차이（P>0.05）；이술후균교본조술전하강（P<0.05），단술후량조환자상술지표간무차이（P>0.05）。술전량조환자조열출한평분，외음、음도불괄평분，관절통평분，Kupperman총분간무차이（P>0.05）；술후관찰조외음、음도불괄평분급Kupperman총분균저우대조조〔（1.1±1.0）분여（2.0±1.5）분，（9.0±1.2）분여（10.5±1.3）분，P<0.05〕，이량조조열출한、관절통평분간무차이（ P>0.05）。술전량조환자통경、만성분강통、성교통평분급주관감수총분간무차이（ P>0.05）；술후관찰조환자만성분강통평분、주관감수총분균저우대조조〔（0.20±0.32）분여（0.40±0.53）분，（2.53±1.21）분여（3.47±1.31）분，P<0.05〕，이량조통경、성교통평분간무차이（ P≥0.05）。결론마부륭가감경중도EM환자GnRH-a치료후인기적저자격소증상，병능유효완해EM적동통증상。
Objective Toinvestigatetheclinicalefficacyofgonadotropin-releasinghormoneagonist(GnRH-a) combinedwithdesogestrel-ethinylestradiolfortreatingsevereendometriosis.Methods Atotalof80patientswithsevereendo-metriosis who were admitted to our hospital and were treated by laparoscopic conservative operation from January 2009 to May 2012,were selected as study subjects. The patients were randomly divided into two groups:control group(38 cases)received GnRH-a treatment alone after operation,while observation group(42 patients)were given the treatment of GnRH-a combined Marvelon after operation. The patients were followed up for 1 year,levels of the endocrine hormones( FSH,LH,E2 ),severity of perimenopausal period syndrome( Kupperman score)and patients'subjective feelings for perimenopausal period syndrome were comparedbetweentwogroupsofpatientsbeforeoperationandin1yearafteroperation.Results Therewasnosignificantdiffer-ence in levels of FSH,LH and E2 between two groups of patients before operation(P>0. 05). For both groups,levels of FSH, LH and E2 after operation were significantly lower than those before operation(P<0. 05),there was no significant difference in levels of FSH,LH and E2 between two groups of patients in 1 year after surgery(P>0. 05). There was no significant difference in hot flushes and sweating score,vulvovaginal discomfort score,joint pain score and Kupperman score between two groups of pa-tients before operation(P>0. 05). The vulvovaginal discomfort score and Kupperman score in observation group were significant lower than those in control group〔(1. 1±1. 0)vs. (2. 0±1. 5),(9. 0±1. 2) vs. (10. 5±1. 3),P<0. 05〕in 1 year after surgery. There was no significant difference in hot flushes and sweating score and joint pain score between two groups in 1 year af-ter surgery(P >0. 05). There was no significant difference in dysmenorrhea score,chronic pelvic pain score,dyspareuniascore and subjective feelings total score between two groups of patients before operation ( P >0. 05 ) . The chronic pelvic pain score and subjective feelings total score in observation group were significant lower than those in control group in 1 year after sur-gery〔(0. 20±0. 32) vs. (0. 40±0. 53),(2. 53±1. 21) vs. (3. 47±1. 31),P<0. 05〕. There was no significant differ-enceindysmenorrheascoreanddyspareuniascorebetweentwogroupsin1yearaftersurgery(P≥0.05).℅onclusion Marvel-on can relieve the low level estrogen-related symptoms caused by GnRH-a treatment among patients with severe endometriosis, and can relieve pain symptom caused by endometriosis.
