腹腔镜手术前后联合醋酸亮丙瑞林治疗子宫内膜异位症的比较研究  

Comparison of Pre-and Post-operative Leuprorelin Acetate for Laparoscopy in the Treatment of Endometriosis

作　　者：王晶[1] 陈滢[1] 杨赛花[1] 

机构地区：[1]广州军区武汉总医院妇产科,武汉430070

出　　处：《中国微创外科杂志》2011年第6期492-495,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜手术与促性腺激素释放激素激动剂（GnRH-a）醋酸亮丙瑞林联合治疗子宫内膜异位症（endometriosis,EM）的临床价值。方法回顾性分析2004年1月~2008年11月395例EM的临床资料,A组133例为腹腔镜术前使用醋酸亮丙瑞林,3.75 mg皮下注射,每28天一次,3个月后再手术;B组150例为腹腔镜术后使用醋酸亮丙瑞林3个月;C组（对照组）112例单纯行腹腔镜手术。比较三组术中情况及远期预后。结果 （1）A组手术时间及术中出血量较B组及C组明显减少[手术时间：A组（146.8±42.5）min、B组（254.4±51.2）min、C组（243.5±48.8）min,术中出血量A组（76.4±31.2）ml、B组（110.7±29.9）ml、C组（101.3±35.4）ml,P均=0.000]。（2）较之C组,A组及B组的总有效率均显著升高,复发率均明显下降（总有效率：C组47.1%、A组75.6%、B组77.9%,复发率：C组37.5%、A组13.0%、B组12.2%,P均=0.000）,A组与B组之间比较无统计学差异（P=0.671,0.849）。（3）随访2年,三组妊娠率比较,差异无统计学意义[A组47.6%（20/42）,B组51.8%（29/56）,C组37.5%（15/40）,P=0.377]。结论较之单纯腹腔镜手术治疗,腹腔镜手术联合GnRH-a治疗EM能提高有效率,降低复发率,但不能明显提高妊娠率。腹腔镜手术前或手术后用药疗效相似,但术前用药更有利于手术实施。Objective To study the value and optimal approach for laparoscopic operation combined with GnRH-a Leuprorelin acetate in the treatment of endometriosis（EM）. Methods A retrospective study was conducted on 395 patients with EM,who were divided into 3 groups： group A： 133 cases,leuprorelin acetate was given three months preoperatively（3.75 mg subcutaneous injection,once 28 days）;group B： 150 cases,leuprorelin acetate was used three months postoperatively;group C（control group）： 112 cases,received laparoscopic operation only.The operative situation and long-term prognosis were compared among the three groups.Results（1） The mean operation time and intraoperative blood loss of group A was significantly less than those in groups B and C [（146.8±42.5） min,（76.4±31.2） ml vs.（254.4±51.2） min,（110.7±29.9） ml and（243.5±48.8） min,（101.3±35.4）ml,both P=0.000].（2） Compared to group C,the effective rate of groups A and B was significantly elevated and the recurrence rate was significantly declined（overall effective rate： C： 47.1%,A： 75.6%,B： 77.9%;recurrence rate： C： 37.5%,A： 13.0%,B： 12.2%,both P=0.000）.There was no statistical significance between group A and group B（P=0.671,0.849）.（3） The three groups were followed up for 2 years,during which we didn＇t detect significant difference in pregnancy rate among the groups [A： 47.6%（20/42）,B： 51.8%（29/56）,C： 37.5%（15/40）,P=0.377]. Conclusions Compared to laparoscopic operation alone,laparoscopic operation combined with GnRH-a is more effective for EM with lower recurrence rate,however,it cannot increase pregnancy rate.Pre-and postoperative leuprorelin acetate have similar efficacy,but pre-operative medication is more favorable to performing the operation.

关 键 词：子宫内膜异位症 促性腺激素释放激素激动剂 醋酸亮丙瑞林 腹腔镜手术 疗效 

分 类 号：R711.71[医药卫生—妇产科学]