子宫内膜异位症保守性手术后应用GnRH-a联合克龄蒙治疗的临床分析  

Clinical analysis of GnRH-a combined with climen in treatment of endometrosis patients after conservative surgery

作　　者：张春燕[1] 赵彦梅[1] 殷汝昌[1] 金辉[1] 张婷婷[1] 

机构地区：[1]泰山医学院附属聊城市第二人民医院妇科,聊城252600

出　　处：《新医学》2013年第2期108-111,共4页Journal of New Medicine

摘　　要：目的:探讨促性腺激素释放激素激动剂(GnRH-a)联合克龄蒙治疗子宫内膜异位症(EMS)保守性手术后的临床疗效和安全性。方法:将75例经腹腔镜或开腹保守手术治疗并经病理证实为EMS的患者分为两组。GnRH-a组:术后第3～5日开始给予GnRH-a治疗,每隔28 d注射1次,连用6次;反加克龄蒙组:给予GnRH-a治疗的同时加用克龄蒙,连续6个月。观察治疗前后两组患者及组间雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)的变化,以及疼痛评分、改良Kupperman评分、骨密度、骨钙素等各项指标的变化。结果:两组E2、FSH及LH治疗后较治疗前降低,反加组E2明显高于GnRH-a组(P<0.05),两组治疗前、后FSH及LH比较差异无统计学意义(P>0.05)。两组疼痛评分比较差异亦无统计学意义(P>0.05);反加组Kupperman评分低于GnRH-a组(P<0.05);GnRH-a组骨密度下降明显,GnRH-a组血清骨钙素较反加组值明显升高(P<0.05)。结论:GnRH-a联合克龄蒙治疗EMS保守性手术后患者,疗效确切,同时减轻单用GnRH-a造成的围绝经期综合征的不良反应,减缓骨转换,防止骨质疏松的发生。GnRH-a联合克龄蒙是治疗EMS的理想方案。Objective： To observe the therapeutic effects and safety of endocrine response of gonadotropin hor- mone releasing hormone-analogue （GnRH-a） combined with Climen in the treatment of advanced endometrosis after conservative laparoscopic operation. Methods： Seventy-five cases of endometriosis patients were randomly divided into two groups ： GnRH-a alone group were treated with GnRH-a by hypodermic injection of six doses, each given at twenty-eight days interval; Add back with Climen group were treated with GnRH-a and Climen during six months. To observe the changes between the two groups before and after treatment, E2, FSH, LH, VAS, Modified Kupperman score, Bone mineral density, BGP etc. were applied. Results： After treatment, E2, FSH and LH of the two groups were declined, E2 of the add back group was significantly higher than that of GnRH-a alone group （P 〈 0.05）, but no difference was found between the two groups in FSH and LH （P 〉 0. 05）. There was no difference in VAS within the two groups （P 〈 0. 05 ）. Compared with the GnRH-a alone group, the add back group were lower in Modified Kupperman score （P 〈 0.05 ）. Bone mineral density of the GnRH-a alone group were declined obviously. BGP of the add back group were lower than of the GnRH-a alone group （ P 〈 0. 05 ）. Conclusion： GnRH-a combined with Climen add-back therapy is effective in the treatmentof advanced endometrosis after conservative laparoscopic operation. It could reduce perimenpausal syndrome caused by GnRH-a and slow down bone conversion to prevent the occurrence of osteoporosis. GnRH-a combined with Climen is the ideal scheme for the treatment of endometriosis.

关 键 词：子宫内膜异位症 促性腺激素释放激素激动剂 克龄蒙 反加疗法 

分 类 号：R713.4[医药卫生—妇产科学]