CAJ | 학술논문

目的：比较子宫内膜异位症腔镜保守性手术术后应用不同药物的疗效及安全性。方法选择165例符合入组标准的子宫内膜异位症患者作为研究对象，所有患者均行腔镜保守性手术，根据术后使用药物不同按随机数字表法分为Ⅰ组（戈舍瑞林），Ⅱ组（米非司酮），Ⅲ组（孕三烯酮），每组各55例，观察临床疗效及安全性。结果Ⅰ组治疗后 E2、CA125、EMAb、痛经 VAS 评分分别为（136．7±3．8）pmol／L、（18．0±2．8）u／mL、（200．8±52．1）pg／mL、（1．91±0．35）分，Ⅱ组分别为（155．0±3．5）pmol／L、（29．4±3．3）u／mL、（265．1±49．8）pg／mL、（1．98±0．44）分，Ⅲ组分别为（158．0±3．2）pmol／L、（31．1±3．5）u／mL、（278．2±45．6）pg／mL、（1．95±0．45）分，均明显低于治疗前（tⅠ组＝10．257、9．029、13．311、7．802，tⅡ组＝8．441、7．083、10．54、6．703，tⅢ组＝7．702、6．448、8．671、6．784，均 P ＜0．01），三组治疗后 E2、CA125、EMAb 差异均有统计学意义（F ＝11．375、8．002、7．671，均 P ＜0．01），Ⅰ组治疗后 E2、CA125、EMAb 明显低于Ⅱ组、Ⅲ组（tⅠ组-Ⅱ组＝3．562、5．017、3．631，tⅠ组-Ⅲ组＝3．268、4．573、4．023，均 P ＜0．05）；Ⅰ组临床总有效率为90．91％，明显高于Ⅱ组、Ⅲ组（χ2＝10．456，P ＜0．05）；Ⅰ组1年妊娠率为50．91％，明显高于Ⅱ组、Ⅲ组（χ2＝7．700，P ＜0．05）。Ⅰ组不良反应发生率为18．18％，Ⅱ组为3．64％，Ⅲ组为29．09％（χ2＝12．732，P ＜0．01）。结论子宫内膜异位症腔镜保守性手术术后应用戈舍瑞林治疗效果确切，且治疗依从性更好，复发率及不良反应发生率更低，妊娠成功率更高，但米非司酮具有更好的经济性及安全性，应根据患者具体情况选用。
목적：비교자궁내막이위증강경보수성수술술후응용불동약물적료효급안전성。방법선택165례부합입조표준적자궁내막이위증환자작위연구대상，소유환자균행강경보수성수술，근거술후사용약물불동안수궤수자표법분위Ⅰ조（과사서림），Ⅱ조（미비사동），Ⅲ조（잉삼희동），매조각55례，관찰림상료효급안전성。결과Ⅰ조치료후 E2、CA125、EMAb、통경 VAS 평분분별위（136．7±3．8）pmol／L、（18．0±2．8）u／mL、（200．8±52．1）pg／mL、（1．91±0．35）분，Ⅱ조분별위（155．0±3．5）pmol／L、（29．4±3．3）u／mL、（265．1±49．8）pg／mL、（1．98±0．44）분，Ⅲ조분별위（158．0±3．2）pmol／L、（31．1±3．5）u／mL、（278．2±45．6）pg／mL、（1．95±0．45）분，균명현저우치료전（tⅠ조＝10．257、9．029、13．311、7．802，tⅡ조＝8．441、7．083、10．54、6．703，tⅢ조＝7．702、6．448、8．671、6．784，균 P ＜0．01），삼조치료후 E2、CA125、EMAb 차이균유통계학의의（F ＝11．375、8．002、7．671，균 P ＜0．01），Ⅰ조치료후 E2、CA125、EMAb 명현저우Ⅱ조、Ⅲ조（tⅠ조-Ⅱ조＝3．562、5．017、3．631，tⅠ조-Ⅲ조＝3．268、4．573、4．023，균 P ＜0．05）；Ⅰ조림상총유효솔위90．91％，명현고우Ⅱ조、Ⅲ조（χ2＝10．456，P ＜0．05）；Ⅰ조1년임신솔위50．91％，명현고우Ⅱ조、Ⅲ조（χ2＝7．700，P ＜0．05）。Ⅰ조불량반응발생솔위18．18％，Ⅱ조위3．64％，Ⅲ조위29．09％（χ2＝12．732，P ＜0．01）。결론자궁내막이위증강경보수성수술술후응용과사서림치료효과학절，차치료의종성경호，복발솔급불량반응발생솔경저，임신성공솔경고，단미비사동구유경호적경제성급안전성，응근거환자구체정황선용。
Objective To compare the efficacy and safety of different drugs in the treatment of patients with endometriosis by laparoscopic conservatism operation.Methods 165 patients with endometriosis met the inclusion were included as research subjects.All patients were treated with laparoscopic conservatism operation,then were divided intoⅠgroup (goserelin),Ⅱ group (mifepristone),Ⅲ group (gestrinone)according to different postoperative medica-tion,55 cases in each group.The clinical efficacy and safety were observed.Results The E2 ,CA125,EMAb,dys-menorrhea VAS scores of Ⅰ group after treatment were (136.7 ±3.8)pmol/L,(18.0 ±2.8)u/mL,(200.8 ± 52.1)pg/mL,(1.91 ±0.35)points,those of Ⅱ group were (155.0 ±3.5)pmol/L,(29.4 ±3.3)u/mL,(265.1 ± 49.8)pg/mL,(1.98 ±0.44)points,those of Ⅲ group were (158.0 ±3.2)pmol/L,(31.1 ±3.5)u/mL,(278.2 ± 45.6)pg/mL,(1.95 ±0.45)points,those in three groups after treatment were significantly lower than before treat-ment(tⅠgroup =10.257,9.029,13.311,7.802,tⅡgroup =8.441,7.083,10.54,6.703,tⅢgroup =7.702,6.448,8.671, 6.784,all P <0.01).There were significant differences between the three groups in E2 ,CA125,EMAb(F =11.375, 8.002,7.671,all P <0.01).The E2 ,CA125,EMAb ofⅠgroup after treatment were significantly lower than Ⅱ,Ⅲgroup(tⅠgroup -ⅡgrouP =3.562,5.017,3.631,tⅠgroup -Ⅲ group =3.268,4.573,4.023,all P <0.05).The total effective rate of I group was 90.91%,which was significantly higher than Ⅱgroup,Ⅲ group(χ2 =10.456,P <0.05).The 1 -year pregnancy rate of I group was 50.91%,which was significantly higher than Ⅱgroup,Ⅲ group(χ2 =7.700,P <0.05).The incidence rate of adverse reactions of I group was 18.18%,which of Ⅱ group was 3.64%,which of Ⅲgroup was 29.09%(χ2 =12.732,P <0.01).Conclusion The goserelin has exact effect in the treatment of patients with endometriosis by laparoscopic conservatism operation,and has better treatment compliance,lower relapse rate and incidence of adverse reactions,higher pregnancy success rate,but the mifepristone has better economy and safety,the patients should be selected according to specific circumstances.