CAJ | 학술논문

目的探讨中、重度内异症患者使用促性腺激素释放激素激动剂(GnRH-a)后联合腹腔镜保守性手术治疗的临床疗效及安全性.方法回顾性分析2007年1月至2010年1月在武汉大学人民医院就诊的68例中、重度内异症患者的临床资料.GnRH-a组25例,术前月经来潮第2天皮下注射GnRH-a(亮丙瑞林)3.75 mg,每4周1次,共3个月；口服避孕药组23例,术前最后1次月经来潮第2天口服避孕药去氧孕烯-炔雌醇片l片,连续21 d为1个疗程,共3个疗程；单纯手术组20例,手术前未用任何药物.3组患者均行腹腔镜手术,术后所有患者随访12个月,比较3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)、复发率等指标.结果 GnRH-a组、口服避孕药组、单纯手术组手术时间分别为(68±18)、(80±21)、(90±24) min；术中出血量分别为(118±15)、(161±18)、(193±13) ml；以上两项指标GnRH-a组均低于另外两组,分别比较,差异均有统计学意义(P＜0.05).GnRH-a组患者术后下床活动时间及肛门排气时间均早于口服避孕药组和单纯手术组,分别比较,差异均有统计学意义(P＜0.05).治疗后随访至术后12个月,GnRH-a组、口服避孕药组以及单纯手术组VAS分别由术前3.8分(1.9 ～6.8分)、2.7分(1.3～5.5分)、1.9分(1.0～4.9分)下降至1.9分(1.1 ～2.8分)、1.8分(1.2 ～3.2分)、1.6分(1.0 ～3.6分),GnRH-a组下降最明显,与其他两组分别比较,差异均有统计学意义(P＜0.05).GnRH-a组、口服避孕药组以及单纯手术组患者随访期间复发率分别为12％ (3/25)、22％(5/23)、25％(5/25),GnRH-a组与其他两组分别比较,差异均有统计学意义(P＜0.05).结论 GnRH-a联合腹腔镜手术治疗内异症手术时间短、术中失血少、术后恢复快、痛经改善效果好、复发率低,短期疗效安全有效.
목적 탐토중、중도내이증환자사용촉성선격소석방격소격동제(GnRH-a)후연합복강경보수성수술치료적림상료효급안전성.방법 회고성분석2007년1월지2010년1월재무한대학인민의원취진적68례중、중도내이증환자적림상자료.GnRH-a조25례,술전월경래조제2천피하주사GnRH-a(량병서림)3.75 mg,매4주1차,공3개월；구복피잉약조23례,술전최후1차월경래조제2천구복피잉약거양잉희-결자순편l편,련속21 d위1개료정,공3개료정；단순수술조20례,수술전미용임하약물.3조환자균행복강경수술,술후소유환자수방12개월,비교3조환자적수술시간、술중출혈량、술후회복정황、동통증상시각모의평분(VAS)、복발솔등지표.결과 GnRH-a조、구복피잉약조、단순수술조수술시간분별위(68±18)、(80±21)、(90±24) min；술중출혈량분별위(118±15)、(161±18)、(193±13) ml；이상량항지표GnRH-a조균저우령외량조,분별비교,차이균유통계학의의(P＜0.05).GnRH-a조환자술후하상활동시간급항문배기시간균조우구복피잉약조화단순수술조,분별비교,차이균유통계학의의(P＜0.05).치료후수방지술후12개월,GnRH-a조、구복피잉약조이급단순수술조VAS분별유술전3.8분(1.9 ～6.8분)、2.7분(1.3～5.5분)、1.9분(1.0～4.9분)하강지1.9분(1.1 ～2.8분)、1.8분(1.2 ～3.2분)、1.6분(1.0 ～3.6분),GnRH-a조하강최명현,여기타량조분별비교,차이균유통계학의의(P＜0.05).GnRH-a조、구복피잉약조이급단순수술조환자수방기간복발솔분별위12％ (3/25)、22％(5/23)、25％(5/25),GnRH-a조여기타량조분별비교,차이균유통계학의의(P＜0.05).결론 GnRH-a연합복강경수술치료내이증수술시간단、술중실혈소、술후회복쾌、통경개선효과호、복발솔저,단기료효안전유효.
Objective To study the efficacy and safety of Gonadotropin-releasing hormone agonists (GnRH-a) combined with laparoscope conservative surgery in treatment of moderate or severe endometriosis.Methods From Jan.2007 to Jan.2010,68 patients with moderate or severe undergoing treatment in Renmin Hospital of Wuhan University were enrolled in this retrospective study.Three groups were classified,which were 25 patients in GnRH-a group,subcutaneous injection Leuprorelin on the second day of menstruation,every 4 weeks for 3 months.Twenty-three patients in Marvelon group,orally one marvelon tablet on the second day of menstruation,continuous 21 days for one period of treatment for 3 courses.Twenty patients in surgery group,without any medicine used preoperatively.All patients were followed by 12 months and compare their surgery time,blood loss,recovery,visual analog scale (VAS),and recurrence and so on.Results The operating time were (68 ± 18) min in GnRH-a group,(80 ± 21) min in Marvelon group and (90± 24) min in surgery group.The amount of bleeding were (118 ± 15) ml in GnRh-a group,(161 ± 18) ml in Marvelon group and (193 ± 13) ml in surgery group.There was significant lower in the operating time and amount of bleeding in GnRH-a group than those in other two groups (P ＜ 0.05).The activity time and the anus exhaust time were shorter in patients in GnRh-a group than those in the other two groups significantly(P ＜ 0.05).When followed up in 12 months after treatment,visual analogue scale had dropped from 3.8 (1.9-6.8) to 1.9 (1.1-2.8) in GnRh-a group,from 2.7 (1.3-5.5) to 1.8 (1.2-3.2) in Marvelon group and from 1.9(1.0-4.9) to 1.6(1.0-3.6) in surgery group.It was showed the most remarkable decreased VAS in GnRHa group when compared with the other two groups(P ＜ 0.05).The recurrence rates were 12％ (3/25) in GnRH-a group,22％ (5/23) in Marvelon group and 25 ％ (5/25) in surgery group.It was found that the most significant lower recurrence was in GnRH-a group when compared with the other two groups (P ＜ 0.05).Conclusions It was safe and efficacy that GnRH-a combined with laparoscopic conservative surgery were used in treatment of endometriosis.It could bring shorter operation time,less intraoperative blood loss,quick postoperative recover,the lower recurrence rate.