CAJ | 학술논문

目的：探讨腹腔镜微创手术联合促性腺激素释放激素激动剂（ gonadotropin releasing hormone antagonist， GnRH－a）治疗中重度子宫内膜异位症（endometriosis，EMT）的临床疗效和安全性。方法分析2012年新泰市人民医院妇产科收治的82例中重度EMT患者临床资料，根据手术治疗前加用药物的不同分为GnRH－a组（28例）、口服避孕药组（28例）和单纯手术组（26例），比较3组患者术中、术后评价指标，疼痛症状视觉模拟评分（ visual analogue scale ， VAS），术后复发率和不良反应发生情况。结果 GnRH－a组较口服避孕药组和单纯手术组手术时间短、术中出血少、肛门排气和下床活动时间早（均P＜0.05）；随访12个月时，GnRH－a组VAS评分降低幅度明显高于其他两组，GnRH－a组复发率明显低于其他两组（均P＜0.05）。 GnRH－a组低雌激素血症发生7例，患者均可以耐受，停止药物治疗后症状均消失；4个月内所有患者月经均恢复正常。结论腹腔镜微创手术联合GnRH－a术前治疗中重度EMT可有效提高手术效果、术后恢复快、复发率低，短期用药安全。
목적：탐토복강경미창수술연합촉성선격소석방격소격동제（ gonadotropin releasing hormone antagonist， GnRH－a）치료중중도자궁내막이위증（endometriosis，EMT）적림상료효화안전성。방법분석2012년신태시인민의원부산과수치적82례중중도EMT환자림상자료，근거수술치료전가용약물적불동분위GnRH－a조（28례）、구복피잉약조（28례）화단순수술조（26례），비교3조환자술중、술후평개지표，동통증상시각모의평분（ visual analogue scale ， VAS），술후복발솔화불량반응발생정황。결과 GnRH－a조교구복피잉약조화단순수술조수술시간단、술중출혈소、항문배기화하상활동시간조（균P＜0.05）；수방12개월시，GnRH－a조VAS평분강저폭도명현고우기타량조，GnRH－a조복발솔명현저우기타량조（균P＜0.05）。 GnRH－a조저자격소혈증발생7례，환자균가이내수，정지약물치료후증상균소실；4개월내소유환자월경균회복정상。결론복강경미창수술연합GnRH－a술전치료중중도EMT가유효제고수술효과、술후회복쾌、복발솔저，단기용약안전。
Objective To investigate the efficacy and safety of laparoscope surgery combined with gonadotropin -releasing hormone agonist ( GnRH-a) in the treatment of moderate or severe endometriosis .Methods Data of 82 patients with moderate to severe endometriosis in Xintai City People’ s Hospital from Jan to Dec.2012 were collected, all cases were divided into GnRH -a group (28 cases), oral contraceptive group (28 cases) and surgery group (26 cases) according to medication treatment before surgery.The indicators of preoperative and postoperative evaluation , pain visual analogue scale ( VAS) , recurrence rate and adverse reaction were compared among the three groups .Results The operative time, the amount of blood loss in GnRH -a group were lower than in those in the other two groups .The activity time and anal exhaust time in GnRH -a group were earlier than those in the other two groups(P<0.05).After 12 months followed-up, the reduction of VAS in GnRH -a group was significantly higher than those in the other two groups .The recurrence rate in GnRH-a group was significantly lower than that in the other two groups (P<0.05).7 patients with low estrogen hyperlipidemia occurred in GnRH -a group, the adverse effects could be tolerated .The symptoms were disappeared when medication treatment stopped .Normal menstruation retrieved for all patients after 4 months.Conclusion The laparoscopic surgery combined with preoperative GnRH -a in treatment of moderate to severe endometriosis can effectively improve surgical effects , which has advantages of fast postoperative recovery , low recurrence rate and safe .