保守性手术联合长效醋酸甲羟孕酮治疗中重度子宫内膜异位症的临床观察  

Conservative surgery combined with depot medroxyprogesterone acetate in treatment of moderate or severe endometriosis

作　　者：周洁[1] 雷贞武[2] 吕杰强[1] 孙静[1] 徐肖文[1] 

机构地区：[1]温州医学院附属第二医院妇产科,325027 [2]四川生殖卫生学院附属医院妇科

出　　处：《中华妇产科杂志》2005年第1期5-8,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：浙江省教委科研基金资助项目 (SJY0 2 0 10 )

摘　　要：目的　探讨长效醋酸甲羟孕酮 (DMPA)用于中重度子宫内膜异位症患者保守性手术后巩固治疗的临床效果及副反应。方法　将资料完整的中重度子宫内膜异位症行保守性手术治疗的患者 94例 ,分为DMPA组、促性腺激素释放激素激动剂 (GnRH a)组及对照组。DMPA组 34例 ,术后月经来潮 5d内 ,深部肌内注射DMPA 15 0mg ,2 8～ 30d注射 1次 ,共 6次 ;GnRH a组 30例 ,术后月经来潮 5d内 ,皮下注射亮丙瑞林 3 75mg ,2 8～ 30d注射 1次 ,共 6次 ;对照组 30例 ,术后未用药物治疗。观察治疗前后患者疼痛症状和体征的临床缓解情况、月经变化、体重改变、肝肾功能及性激素水平变化。结果　DMPA组及GnRH a组患者疼痛症状和体征完全缓解率分别为 88%及 93% ,显著高于对照组的 5 3% ,差异有统计学意义 (χ2 =12 2 73,P <0 0 1;χ2 =9 6 0 4 ,P <0 0 1) ,DMPA组及GnRH a组患者累积复发率分别为 6 %及 7% ,显著低于对照组的 2 7% (χ2 =5 2 2 2 ,P <0 0 5 ;χ2 =4 32 0 ,P <0 0 5 ) ,而DMPA组与GnRH a组比较 ,差异无统计学意义 (χ2 =0 4 88,P >0 0 5 ;χ2 =0 0 17,P >0 0 5 )。DMPA组用药前雌二醇水平为 (2 0 0± 15 ) pmol/L ,用药后雌二醇水平显著下降至(12 0± 9) pmol/L ,但仍维持在卵泡早期水平。GnRH a组用药前?Objective To evaluate the efficiency and side effects of depot medroxyprogesterone acetate in the treatment of moderate or severe endometriosis after conservative surgery Methods Ninety four women with moderate or severe endometriosis after conservative surgery were divided into three groups: 34 cases in the group of depot medroxyprogesterone acetate(DMPA) received intramuscularly depot medroxyprogesterone acetate 150 mg every 28 30 days for 6 months; 30 cases in the group of gonadotropin releasing hormone agonists (GnRH a) received hypodermically leuprorelin acetate 3 75 mg every 28 30 days for 6 months; 30 cases in the group of control did not receive any postoperative medical treatment Patients′symptoms and signs including pelvic pain, pelvic tenderness, menstrual and weight changes were recorded before and after treatment. Liver and renal functions, sex hormone level were also examined at the same time Results Both DMPA and GnRH a treatment achieved similar significant relief of pelvic symptoms and signs(88% and 93%) compared with the control group (χ 2=12 273, P <0 01; χ 2=9 604, P <0 01) The cumulative recurrence rates of DMPA and GnRH a groups were 6% and 7%, significantly lower than that of the control group (χ 2=5 222, P <0 05; χ 2=4 320, P <0 05) There were no significant differences between DMPA and GnRH a groups(χ 2=0 488, P >0 05;χ 2=0 017, P >0 05) Serum estradiol(E 2) level was significantly reduced in both DMPA and GnRH a groups, but serum E 2 was maintained at the level of early follicular phase in the group of DMPA (120±9) pmol/L and menopause phase level in the group of GnRH a (62±9) pmol/L The main side effects of DMPA were menstrual changes, weight gain and delay of ovulation Conclusion Depot medroxyprogesterone acetate seems to be an effective, safe, and convenient treatment for endometriosis with low cost, good compliance, and few side effects

关 键 词：手术治疗 醋酸甲羟孕酮 子宫内膜异位症 亮丙瑞林 

分 类 号：R713[医药卫生—妇产科学]