腹腔镜联合促性腺激素释放激素激动剂治疗有生育要求子宫内膜异位症患者的临床疗效评价  

The clinical efficacy of the laparoscope with gonadotropin releasing hormone agonist in the treatment of endometriosis women with fertility requirements

作　　者：吴玲姣[1] 邓晓杨[1] 徐蕾[1] 朱晓莺[1] 邓洁[1] 吴海燕[1] 徐瑶[1] WU Ling-jiao;DENG Xiao-yang;XU Lei;ZHU Xiao-ying;DENG Jie;WU Hai-yan;XU Yao(Department of Gynecology Surgery,The First Affiliated Hospital,Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院妇科

出　　处：《实用医院临床杂志》2019年第5期33-36,共4页Practical Journal of Clinical Medicine

摘　　要：目的研究腹腔镜联合促性腺激素释放激素激动剂(GnRH-a)治疗子宫内膜异位症(EMs)的疗效及对妊娠结局的影响。方法选取2015年6月至2017年5月我院收治的有生育要求EMs患者164例,依照随机数字表法分为联合组与腹腔镜组各82例。腹腔镜组行腹腔镜治疗,联合组行腹腔镜与GnRH-a联合治疗。观察两组术前及术后6个月血清促卵泡刺激素(FSH)、促黄体生成激素(LH)、雌二醇(E 2)等性激素水平,血清基质金属蛋白酶-9(MMP-9)、组织抑制因子-1(TIMP-1)及骨桥蛋白(OPN)等肿瘤相关因子水平,痛经程度,治疗后2年内妊娠结局。结果术后6个月,联合组FSH、LH、E 2、MMP-9、TIMP-1、OPN、痛经VAS得分均低于腹腔镜组(P<0.05);联合组有效率、妊娠率、活胎率大于腹腔镜组,复发率、未孕率低于腹腔镜组(P<0.05);在妊娠患者中联合组剖宫产率小于腹腔镜组(P<0.05),两组流产率、胎儿窘迫率、早产率、新生儿窒息率差异无统计学意义(P>0.05)。结论腹腔镜与GnRH-a联合治疗EMs可有效清除、减灭病灶,降低雌激素水平,改善妊娠结局,抑制肿瘤相关因子,避免术后复发。Objective To investigate the clinical efficacy of the laparoscope with gonadotropin releasing hormone(GnRH)agonist in the treatment of women with endometriosis(EMs)and the effects on pregnancy outcome..Methods We selected 164 EMs patients with fertility requirements in our hospital from June 2015 to May 2017 for the study.The patients were divided into combined group(n=82)and laparoscopy group(n=62)using random number table method.Laparoscope was given to the laparoscope group and laparoscope with GnRH agonist was given to the combined group.Before and after 6 months of operation,levels of serum follicular stimulating hormone(FSH),luteinizing hormone(LH),estradiol 2(E 2),and tumor related factor including matrix metalloproteinase-9(MMP-9),tissue inhibitor metalloproteinase factor-1(TIMP-1)and osteopontin(OPN),degree of dysmenorrheal and pregnancy outcome within 2 years after treatment were observed..Results After 6 months of treatment,the levels of FSH,LH,E 2,MMP-9,TIMP-1,OPN and the VAS score for dysmenorrhea in the combined group were lower than those in the laparoscopy group(P<0.05).The effective rate,pregnancy rate and live pregnancy rate in the combined group were higher than those in the laparoscopy group(P<0.05).Among the pregnant patients,cesarean section rate in the combined group was lower than that in the laparoscopic group(P<0.05).The recurrence rate and non-pregnancy rate in the combined group were lower than those in the laparoscopy group(P<0.05).There was no difference in abortion rate,fetal distress rate,preterm delivery rate and neonatal asphyxia rate between the two groups(P>0.05).Conclusion Combined treatment of EMs with laparoscopy and GnRH agonist can effectively remove or reduce the lesion,decrease the estrogen level,improve the pregnancy outcome,inhibit the tumor-related factors and avoid the postoperative recurrence.

关 键 词：腹腔镜 促性腺激素释放激素激动剂 子宫内膜异位症 妊娠结局 

分 类 号：R711.71[医药卫生—妇产科学]