腹腔镜下保留神经手术联合GnRH-a治疗深部浸润型子宫内膜异位症的疗效分析  

Efficacy of laparoscopic nervesparing surgery combined with GnRH-a for deeply infiltrated endometriosis

作　　者：魏刚[1] 史欣[1] 王恒[1] 韦君丽[1] Wei Gang;Shi Xin;Wang Heng;Wei Junli(The Fourth Hospital of Xi＇an,Xi＇an 710004,China)

机构地区：[1]陕西省西安市第四医院,西安710004

出　　处：《广西医科大学学报》2018年第11期1543-1547,共5页Journal of Guangxi Medical University

摘　　要：目的:探讨腹腔镜下保留神经手术联合促性腺释放激素激动剂(GnRH-a)治疗深部浸润型子宫内膜异位症(DIE)的临床疗效及机制。方法:将88例DIE患者随机分为观察组与对照组,每组44例。两组均行腹腔镜下保留神经手术治疗,观察组术后应用GnRH-a,对照组术后应用孕三烯酮。比较两组临床疗效、并发症、复发率及血清糖类抗原199(CA199)、基质金属蛋白酶-9 (MMP-9)、基质金属蛋白酶抑制剂-1(TIMP-1)和Th1/Th2细胞因子水平。结果 :术后6个月,观察组血清CA199、MMP-9、MMP-9/TIMP-1、白介素(IL)-4、IL-6、IL-10均显著低于对照组,TIMP-1、γ干扰素(IFN-γ)、IL-2均明显高于对照组(均P<0.05)。术后3个月、6个月、12个月,观察组疼痛视觉模拟量表(VAS)评分显著低于对照组(P<0.05)。两组治疗总有效率比较,差异无统计学意义(97.62%vs 90.24%,P>0.05),但观察组治愈率显著高于对照组(78.57%vs.53.66%,P<0.05)。观察组复发率显著低于对照组(4.88%vs.21.62%,P<0.05),妊娠率显著高于对照组(44.44%vs.20.00%,P<0.05)。结论:腹腔镜下保留神经手术联合GnRH-a治疗DIE安全、有效,能够降低复发率,其机制可能与调节Th1/Th2细胞平衡和MMP-9/TIMP-1平衡有关。Objective： To investigate the clinical efficacy and mechanism of laparoscopic nervesparing surgery combined with GnRH-a for the treatment of deeply infiltrated endometriosis （DIE）.Methods： A total of 88 patients with DIE were randomly divided into an observation group and a control group,with 44 cases in each group.All patients received laparoscopic nervesparing surgery.The patients in the observation group were treated with GnRH-a after surgery,and those in the control group were treated with gestrinone after surgery.The clinical efficacy,the incidence of complications and the recurrence rate were compared between the two groups.The serum CA199,TIMP-1,MMP-9 and Th1/Th2 cytokines levels were measured before and after surgery.Results： After 6 months of surgery,the serum levels of CA199,MMP-9,MMP-9/TIMP-1,IL-4,IL-6 and IL-10 in the observation group were significantly lower than those in the control group,while the levels of TIMP-1,IFN-γ and IL-2 were significantly higher （ P 〈0.05）.3,6 and 12 months after surgery,the VAS score in the observation group was notably lower than that in the control group （ P 〈0.05）.There was no significant difference in the total effective rate between the two groups （97.62% vs .90.24%, P 〉0.05）,but the cure rate was statistically significant （78.57% vs. 53.66%, P 〈0.05）.The recurrence rate in the observation group was significantly lower than that in the control group （4.88% vs. 21.62%, P 〈0.05）,and the pregnancy rate was significantly higher （44.44% vs. 20.00%, P 〈0.05）.Conclusion： Laparoscopic nerves paring surgery combined with GnRH-a was safe and effective for DIE,which could reduce the recurrence rate.The mechanism might be related to the regulation of Th1/Th2 and MMP-9/TIMP-1 balance.

关 键 词：深部浸润型子宫内膜异位症 腹腔镜 保留神经手术 GNRH-A 

分 类 号：R713.4[医药卫生—妇产科学]