反向添加疗法在子宫内膜异位症治疗中的临床意义  

Clinical significance of add-back therapy in the treatment for endometriosis

作　　者：纪霞[1] 张松灵[1] 于美玲[1] 张晓霞[1] 

机构地区：[1]吉林大学第一医院妇产科,吉林省长春市130000

出　　处：《实用医学杂志》2012年第24期4079-4081,共3页The Journal of Practical Medicine

摘　　要：目的:探讨中、重度子宫内膜异位症(EMs)患者保守性手术后应用GnRH-a预防复发以及小剂量雌激素反向添加疗法的临床意义。方法:将136例保守性手术治疗后的Ⅲ～Ⅳ期EMs患者随机分成两组,单一用药组为术后单独给予GnRH-a(达菲林)治疗患者68例,联合用药组为术后给予GnRH-a(达菲林)联合小剂量雌激素制剂(利维爱)治疗患者68例;比较两组患者血清E2、FSH、LH水平变化、副反应及严重程度(以改良Kupperman评分表示)和复发率。结果:用药3个月后,单一用药组血清E2:(40.6±18.9)pmol/L,联合用药组血清E2:(80.8±21.8)pmol/L,两组比较差异有显著性(P<0.05)。两组副反应表现为潮热出汗、性生活障碍等,其中单一用药组发生潮热出汗症状患者60例(88.2%),联合用药组发生22例(32.3%),两组比较差异有显著性(P<0.05);单一用药组与联合用药组的改良Kupperman评分总分分别为(14.2±3.1)分和(6.6±4.2)分,两组比较差异有显著性(P<0.05)。单一用药组与联合用药组的复发率分别为10.3%(7/68)和8.8%(6/68),两组比较差异无显著性(P>0.05)。结论:中、重度子宫内膜异位症保守性手术后应用达菲林和小剂量利维爱作为反向添加可以有效的提高患者的血清E2水平、改善达菲林的副反应,并且不增加复发的风险。Objective To analyze the clinical significances of GnRH-a or low dose estrogen add-back therapy in preventing recurrence in patients with mild or severe endometriosis, who bad received conservative surgery. Methods 136 patients with stage III-IV endometriosis after conservative surgery were randomly divided into 2 groups： 68 patients in single drug group reveived？ GnRH-a （Dophereline） treatment, and 68 patients in add- on drug group received GnRH-a （Dophereline） in combination with low dose of estrogen （Tibolone Tablets）. Changes of serum levels of E2, FSH and LH, side effects, serious degree （with improved Kupperman score measured） and the recurrence rate were compared between the two groups. Results Serum levels of E2 in single drug group and add-on drug group were （40.6 ＋ 18.9） pmol/L and （80.8 ＋ 21.8） pmol/L after 3 months of treatment （P 〈 0.05 ）. Side effects such as hot flashes diaphoresis was shown in 60 patients （88.2%） in single drug group and 22 patients （32.3%） in add-on drug group （P 〈 0.05）. The improved Kupperman total scores in the two groups were （14.2 ＋ 3.1 ） p^ints and （6.6 ＋ 4.2） points （P 〈 0.05）, respectively; and the recurrence rates were 10.3% （7/68） and 8,8% （6/68） （P 〉 0.05）, respectively. Conclusion Dopherelin and low dose estrogen of Tibolone Tablets as the add-back therapy for mild and severe endometriosis after conservative surgery can effectively increase the serum level of E2 and improve Dophereline side effects, and do not increase the risk of recurrence.

关 键 词：子宫内膜异位症 反向添加疗法 达菲林 利维爱 

分 类 号：R711.71[医药卫生—妇产科学]