长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在子宫内膜异位症治疗中的应用效果  

Effect of long acting glucocorticoid combined with gonadotropin-releasing agonist laparoscopic irrigation in the treatment of endometriosis

作　　者：孟宪宁 李红霞[1] 霍志平[1] 吴亚男 王宏利[1] 郝媛媛[1] MENG Xianning;LI Hongxia;HUO Zhiping;WU Ya＇nan;WANG Hongli;HAO Yuanyuan(Department of Obstetrics and Gynecology,Central Hospital of China National Petroleum Company,Hebei Province,Langfang 065000,China)

机构地区：[1]中国石油天然气集团公司中心医院妇产科,河北廊坊065000

出　　处：《中国医药导报》2018年第29期74-78,共5页China Medical Herald

基　　金：河北省廊坊市科学技术研究与发展计划项目(2017013145)

摘　　要：目的探讨长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在子宫内膜异位症(EMS)治疗中的应用效果。方法选择2014年1月～2016年12月中国石油天然气总公司中心医院择期行腹腔镜手术治疗的EMS患者69例为研究对象,根据术中冲洗方法不同将其分为两组,对照组34例采用腹腔镜电凝烧灼术,术中以0.9%生理盐水1000 mL反复冲洗盆腔;研究组35例治疗方法同对照组,术中冲洗以0.9%生理盐水500 m L+20 mg地塞米松及0.9%生理盐水+曲普瑞林3.75 mg,先以生理盐水地塞米松灌洗液冲洗,再以曲普瑞林稀释液灌洗。观察两组患者术前及术后3、6、12个月时间痛经、盆腔痛及性交痛情况,炎性因子水平变化;术后随访1年,观察两组患者受孕、复发及不良反应情况。结果两组术后1、3 d炎性因子C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平均低于同组术前(P <0.05);研究组术后1 d CRP、IL-6及TNF-α水平均低于同期对照组(P <0.05);两组术后3、6、12个月视觉模拟评分法(VAS)评分均低于同组治疗前(P <0.05),研究组术后6、12个月VAS评分低于对照组同期(P <0.05);术后随访1年,研究组自然受孕率为65.71%,高于对照组的38.24%(P <0.05),研究组复发率为2.86%,低于对照组的29.41%(P <0.05),两组随访期间不良反应总发生率比较,差异无统计学意义(P> 0.05)。结论长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在治疗EMS中,可降低炎性因子水平及术后疼痛度,提高1年自然受孕率,值得临床推广。Objective To explore the application effect of long acting glucocorticoid combined with gonadotropin releasing agonist laparoscopic irrigation in endometriosis （EMS）. Methods From January 2014 to December 2016, 69 patients with EMS treated by laparoscopic surgery in Central Hospital of China National Petroleum Company were selected as the study objects. Patients were divided into two groups according to washing methods. Thirty-four cases in the control group, and laparoscopic electrocoagulation and cauterization were used to wash pelvic cavity repeatedly with 1000 mL of 0.9% physiological saline during operation. Thirty-five cases in the experimental group were treated with the same method as the control group. Intraoperative irrigation was done with 0.9 % saline 500 mL ＋ 20 mg Dexam- ethasone and 0.9% saline ＋ Triptorelin 3.75 mg, first with saline Dexamethasone lavage fluid, and then with Triptorelin diluent lavage. The changes of dysmenorrhea, pelvic pain, sexual intercourse pain and inflammatory factor levels in the two groups before and after operation for 3, 6 and 12 months were observed. All patients were followed up for 1 year after operation, and the pregnancy, recurrence and adverse reactions were observed. Results One day and three day af- ter operation, the serum levels of C reactive protein （CRP）, interleukin-6 （IL-6） and tumor necrosis factor （TNF-α） in the two groups were lower than those before operation （P 〈 0.05）. One day after operation, the levels of CRP, IL-6, and TNF-α in the experimental group were lower than those of the control group （P 〈 0.05）; the visual analogue score （VAS） scores at 3 and 12 months post-operatively in both groups were lower than those before operation; and the 3, 6 and 12 months postoperatively were low- er than those before the same group （P 〈 0.05）, 6 and 12 month postoperative the VAS scores of the study group were lower than those of the control group （P 〈 0.05）. The rate of spontaneous pregnancy in the experimenta

关 键 词：糖皮质激素 促性腺激素释放激动剂 腹腔镜 术腔冲洗 子宫内膜异位症 

分 类 号：R711.71[医药卫生—妇产科学]