雌二醇凝胶用于子宫内膜异位症手术联合GnRHa治疗中的临床意义  

The clinical significance of estradiol gel applying to the therapy of operation combined with GnRHa in endometriosis

作　　者：郭慧[1] 吴佳捷[1] 赵延华[1] 阳婷[1] 高雨琪 刘心怡[1] 

机构地区：[1]中南大学湘雅医院妇产科,长沙410008

出　　处：《中国医师杂志》2016年第2期224-227,共4页Journal of Chinese Physician

摘　　要：目的探讨雌二醇（E2）凝胶用于保守性手术辅以促性腺激素释放激素激动剂（Gn—RHa）治疗中、重度内异症患者副反应的疗效及耐受性。方法选取2013年2月至2014年8月中南大学湘雅医院由同一术者行保守性手术后联合戈舍瑞林治疗4—6个月的中重度卵巢子宫内膜异位囊肿（Ⅲ～Ⅳ期）患者共60例，按随机数字表法分为3组，每组20例：对照组：单用戈舍瑞林；治疗组A：戈舍瑞林联合雌二醇凝胶；治疗组B：戈舍瑞林联合替勃龙。比较3组患者用药不同时间后的血清E2、卵泡刺激素（FSH）、黄体生成素（LH）水平，副反应发生率及术后复发率。结果治疗3个月后，治疗组患者的血清E2水平明显高于对照组（P〈0．05），治疗组A血清E2水平稍高于治疗组B，但差异无统计学意义（P〉0．05）；治疗3个月后，治疗组患者kupperman评分、潮热出汗、疲乏、失眠的发生率均低于对照组（P〈0．05）。3组患者阴道流血的发生率及术后复发率比较差异均无统计学意义（P〉0．05）。结论卵巢子宫内膜异位囊肿保守性手术辅以戈舍瑞林联合雌二醇凝胶作为反向添加能有效提高患者的血清E2水平、改善低雌激素症状，亦不增加阴道流血及术后复发的风险。Objective To investigate the efficacy and tolerability of estradioI （E2 ） gel with postop- erative patients of moderately severe ovarian endometriosis cyst, who suffer from the side effect of GnRH agonist. Methods Sixty samples were selected with stage Ⅲ-Ⅳ ovarian endometriosis after conservative operation by the same operator at the Department of Gynecology, Xiangya Hospital, Central South University, between February 2013 and August 2014. All of the patients after surgeries were randomly divided into three groups： control group （ n = 20） with only goserelin injection after conservative surgery, treatment group A （ n = 20） who received estradiol gel, and treatment group B （ n = 20） who received tibolone as an add-back therapy. The serum E2, follicle stimulating hormone （FSH）, luteinizing hormone （LH）, hypoestrogenic symptoms, the incidence of uterine bleeding, and the recurrence after conservative operation were compared among three groups. Results Three months later aster treatment with goserelin, the serum level of E2 of three groups showed statistically significant difference （ P 〈 0. 05 ）. Serum E2 level of treatment group A was not significantly higher than treatment group B （ P 〉 0. 05 ）. The kupperman sore, the incidence of hot flashes sweating, tiring, and agrypnia of treatment groups A and B were significantly lower than the control group （ P 〈 0. 05 ）. The incidence of uterine bleeding and recurrence dont differ sharply among three groups （ P 〉 0.05 ）. Condusions GnRHa combined with estradiol gel can improve symptoms of postoperative patients, reduce side effects effectively, and avoid increase of the risk of vagina bleeding and relapse.

关 键 词：雌二醇/投药和剂量 凝胶类/投药和剂量 子宫内膜异位症/治疗 促性腺素释放激素/激动剂/投药和剂量 

分 类 号：R713.4[医药卫生—妇产科学]