中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
8期
584-588
,共5页
宋菁华%鲁桦%张军%李斌
宋菁華%魯樺%張軍%李斌
송정화%로화%장군%리빈
子宫内膜异位症%腹腔镜检查%促性腺素释放激素%亮丙瑞林
子宮內膜異位癥%腹腔鏡檢查%促性腺素釋放激素%亮丙瑞林
자궁내막이위증%복강경검사%촉성선소석방격소%량병서림
Endometriosis%Laparoscopy%Gonadotropin-releasing hormone%Leuprolide
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)治疗内异症的临床疗效和安全性.方法 选取北京安贞医院2010年1-12月收治的198例内异症患者,分成3组,腹腔镜组52例,单纯行腹腔镜手术治疗；亮丙瑞林组76例,腹腔镜手术后加用国产醋酸亮丙瑞林(其他名称:贝依)3.75 mg/28 d × 3；戈舍瑞林组70例,腹腔镜手术后加用进口醋酸戈舍瑞林(其他名称:诺雷德)3.6 mg/28 d×3.比较3组的临床疗效、妊娠率及药物不良反应.结果 198例患者中13例失访,其中腹腔镜组3例,亮丙瑞林组6例,戈舍瑞林组4例.(1)有效率:临床有效率腹腔镜组为47％(23/49)、亮丙瑞林组为77％ (54/70)、戈舍瑞林组为74％ (49/66),亮丙瑞林组和戈舍瑞林组临床有效率均明显高于腹腔镜组,差异有统计学意义(P＜0.05)；亮丙瑞林组和戈舍瑞林组间临床有效率比较,差异无统计学意义(P＞0.05).(2)复发率:复发率腹腔镜组33％ (16/49)、亮丙瑞林组为13％(9/70)、戈舍瑞林组为12％ (8/66),亮丙瑞林组和戈舍瑞林组复发率均明显低于腹腔镜组,差异有统计学意义(P＜0.05)；亮丙瑞林组和戈舍瑞林组间复发率比较,差异无统计学意义(P＞0.05).(3)妊娠率:腹腔镜组、亮丙瑞林组、戈舍瑞林组中有生育要求者分别为28例、39例和35例.术后随访2年,亮丙瑞林组、戈舍瑞林组的总妊娠率高于腹腔镜组[分别为62％(24/39)、60％ (21/35)、39％(11/28)],但3组间比较,差异无统计学意义(P＞0.05).(4)药物不良反应:药物不良反应主要为低雌激素症状及初始效应(阴道不规则出血),发生率亮丙瑞林组为21％ (15/70)、戈舍瑞林组为20％(13/66),两组比较,差异无统计学意义(P＞0.05).结论 与单纯腹腔镜手术相比,腹腔镜手术联合GnRH-a治疗内异症能提高总的临床有效率和妊娠率,降低复发率；药物不良反应发生率低；国产醋酸亮丙瑞林治疗内异症安全、有效,与进口制剂相比疗效无明显差异.
目的 探討腹腔鏡手術聯閤促性腺激素釋放激素激動劑(GnRH-a)治療內異癥的臨床療效和安全性.方法 選取北京安貞醫院2010年1-12月收治的198例內異癥患者,分成3組,腹腔鏡組52例,單純行腹腔鏡手術治療；亮丙瑞林組76例,腹腔鏡手術後加用國產醋痠亮丙瑞林(其他名稱:貝依)3.75 mg/28 d × 3；戈捨瑞林組70例,腹腔鏡手術後加用進口醋痠戈捨瑞林(其他名稱:諾雷德)3.6 mg/28 d×3.比較3組的臨床療效、妊娠率及藥物不良反應.結果 198例患者中13例失訪,其中腹腔鏡組3例,亮丙瑞林組6例,戈捨瑞林組4例.(1)有效率:臨床有效率腹腔鏡組為47％(23/49)、亮丙瑞林組為77％ (54/70)、戈捨瑞林組為74％ (49/66),亮丙瑞林組和戈捨瑞林組臨床有效率均明顯高于腹腔鏡組,差異有統計學意義(P＜0.05)；亮丙瑞林組和戈捨瑞林組間臨床有效率比較,差異無統計學意義(P＞0.05).(2)複髮率:複髮率腹腔鏡組33％ (16/49)、亮丙瑞林組為13％(9/70)、戈捨瑞林組為12％ (8/66),亮丙瑞林組和戈捨瑞林組複髮率均明顯低于腹腔鏡組,差異有統計學意義(P＜0.05)；亮丙瑞林組和戈捨瑞林組間複髮率比較,差異無統計學意義(P＞0.05).(3)妊娠率:腹腔鏡組、亮丙瑞林組、戈捨瑞林組中有生育要求者分彆為28例、39例和35例.術後隨訪2年,亮丙瑞林組、戈捨瑞林組的總妊娠率高于腹腔鏡組[分彆為62％(24/39)、60％ (21/35)、39％(11/28)],但3組間比較,差異無統計學意義(P＞0.05).(4)藥物不良反應:藥物不良反應主要為低雌激素癥狀及初始效應(陰道不規則齣血),髮生率亮丙瑞林組為21％ (15/70)、戈捨瑞林組為20％(13/66),兩組比較,差異無統計學意義(P＞0.05).結論 與單純腹腔鏡手術相比,腹腔鏡手術聯閤GnRH-a治療內異癥能提高總的臨床有效率和妊娠率,降低複髮率；藥物不良反應髮生率低；國產醋痠亮丙瑞林治療內異癥安全、有效,與進口製劑相比療效無明顯差異.
목적 탐토복강경수술연합촉성선격소석방격소격동제(GnRH-a)치료내이증적림상료효화안전성.방법 선취북경안정의원2010년1-12월수치적198례내이증환자,분성3조,복강경조52례,단순행복강경수술치료；량병서림조76례,복강경수술후가용국산작산량병서림(기타명칭:패의)3.75 mg/28 d × 3；과사서림조70례,복강경수술후가용진구작산과사서림(기타명칭:낙뢰덕)3.6 mg/28 d×3.비교3조적림상료효、임신솔급약물불량반응.결과 198례환자중13례실방,기중복강경조3례,량병서림조6례,과사서림조4례.(1)유효솔:림상유효솔복강경조위47％(23/49)、량병서림조위77％ (54/70)、과사서림조위74％ (49/66),량병서림조화과사서림조림상유효솔균명현고우복강경조,차이유통계학의의(P＜0.05)；량병서림조화과사서림조간림상유효솔비교,차이무통계학의의(P＞0.05).(2)복발솔:복발솔복강경조33％ (16/49)、량병서림조위13％(9/70)、과사서림조위12％ (8/66),량병서림조화과사서림조복발솔균명현저우복강경조,차이유통계학의의(P＜0.05)；량병서림조화과사서림조간복발솔비교,차이무통계학의의(P＞0.05).(3)임신솔:복강경조、량병서림조、과사서림조중유생육요구자분별위28례、39례화35례.술후수방2년,량병서림조、과사서림조적총임신솔고우복강경조[분별위62％(24/39)、60％ (21/35)、39％(11/28)],단3조간비교,차이무통계학의의(P＞0.05).(4)약물불량반응:약물불량반응주요위저자격소증상급초시효응(음도불규칙출혈),발생솔량병서림조위21％ (15/70)、과사서림조위20％(13/66),량조비교,차이무통계학의의(P＞0.05).결론 여단순복강경수술상비,복강경수술연합GnRH-a치료내이증능제고총적림상유효솔화임신솔,강저복발솔；약물불량반응발생솔저；국산작산량병서림치료내이증안전、유효,여진구제제상비료효무명현차이.
Objective To study the effectiveness and safety of combined laparoscopy and gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis (EM).Methods From January to December 2010,198 patients with EM undergoing treatment in Department of Obstetrics and Gynecology,Beijing Anzhen Hospital were randomly divided into three groups,which include 52 cases treated by only laparoscopy in laparoscopy group; 76 cases treated by laparoscopy combined with domestic Leuprolide acetate with dose of 3.75 mg every 28 days in Leuprolide acetate group; 70 cases treated by laparoscopy combined with imported Goserelin acetate with dose of 3.6 mg every 28 days in Goserelin acetate group.The efficacy,pregnancy rate and adverse reactions were compared among the three groups.Results Thirteen cases lost following up,including 3 cases in laparoscopy group,6 cases in Leuprolide acetate group and 4 cases in Goserelin acetate group.(1) Effective rates:effective rates were 47 ％ (23/49)in laparoscopy group,77％ (54/70)in Leuprolide acetate group and 74％ (49/66)in Goserelin acetate group.Compared with laparoscopy group,the effective rate of Leuprolide acetate group and Goserelin acetate group was significantly elevated (P ＜ 0.05).There was no statistically significant difference between Leuprolide acetate group and Goserelin acetate group (P ＞ 0.05).(2) Recurrence rate:recurrence rate were 33％ (16/49) in laparoscopy group,13％ (9/70)in Leuprolide acetate group and 12％ (8/66)in Goserelin acetate group.Compared with laparoscopy group,the recurrence rate of Leuprolide acetate group and Goserelin acetate group was significantly declined (P ＜ 0.05).There was no statistically significant difference between Leuprolide acetate group and Goserelin acetate group (P ＞ 0.05).(3) Pregnancy rate:the number of patients require fertility were 28 cases in laparoscopy group,39 cases in Leuprolide acetate group and 35 cases in Goserelin acetate group.After 2 years follow up,pregnancy rate of 62％ (24/39) in Leuprolide acetate group and 60％ (21/35)in Goserelin acetate group were high than 39％ (11/28)in laparoscopy group significantly,which did not reached significant difference (P ＞ 0.05).(4) Adverse drug reaction:rates of a adverse reactions were 21％ (15/70) in Leuprolide acetate group and 20％ (13/66) in Goserelin acetate group,including irregular vaginal bleeding associated with low estrogen level.There was no significant difference in adverse reactions (P ＞ 0.05).Conclusions Compared with laparoscopy alone,laparoscopy combined with GnRH-a is more effective in treatment of,which exhibit lower recurrence rate,higher pregnancy rate and fewer adverse reactions.Domestic Leuprolide acetate have similar safety and efficacy compared with imported GnRH-a.
