罗氏内异方联合GnRH-a对Ⅲ~Ⅳ期子宫内膜异位症不孕患者术后复发率和妊娠率影响的回顾性研究  

Retrospective Study on Postoperative Recurrence and Pregnancy Rate of StageⅢ-ⅣEndometriosis Infertility Patients Treated by Luoshi Endometriosis Formula Combined with GnRH-a

作　　者：黄亚南 王勇 裴芳利[2] 郑聪聪 曾玉燕[3] 曾诚[2] HUANG Ya-Nan;WANG Yong;PEI Fang-Li;ZHENG Cong-Cong;ZENG Yu-Yan;ZENG Cheng(The Affiliated Traditional Chinese Medicine Hospital of Guandzhou Medical University,Guangzhou 510130 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广州医科大学附属中医医院,广东广州510130 [2]广州中医药大学第一附属医院,广东广州510405 [3]广东省中医院,广东广州510120

出　　处：《广州中医药大学学报》2020年第5期850-855,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81904233);广东省中医药局科研项目(编号:20171111);广州中医药大学第一附属医院高水平手术鼓励计划项目(编号:2019ZD02)。

摘　　要：【目的】观察罗氏内异方联合促性腺激素释放激素激动剂(GnRH-a)对美国生殖医学学会(ASRM)分期为Ⅲ~Ⅳ期的子宫内膜异位症(简称内异症)患者术后复发率和妊娠率的影响。【方法】根据腹腔镜术后治疗方案,将144例经术后病理证实的ASRM分期为Ⅲ~Ⅳ期的内异症患者分为中药组33例、西药组29例、中西药组43例和对照组39例,其中有生育要求的不孕患者分别有31例、26例、40例和30例。所有患者均给予术后常规处理,在此基础上,中药组给予罗氏内异方治疗,西药组给予GnRH-a治疗,中西药组给予罗氏内异方联合GnRH-a治疗,对照组未使用罗氏内异方和GnRH-a治疗,疗程为3个月。观察各组患者术后6个月内异症的复发情况及有生育要求患者术后2年内的妊娠情况,评价2组患者的临床疗效及安全性。【结果】(1)治疗3个月后,中药组、西药组、中西药组和对照组的总有效率分别为60.61%(20/33)、55.17%(16/29)、53.49%(23/43)和48.72%(19/39),组间比较,差异均无统计学意义(P>0.05)。(2)各组术后复发率比较,差异有统计学意义(P<0.05)。组间两两比较(采用Bonferroni方法调整α水平,α’=0.0038),中西药组的复发率明显低于对照组,差异有统计学意义(P<0.0038);而中药组和西药组的复发率均有低于对照组趋势,但差异均无统计学意义(P>0.0038)。(3)各组患者术后第1年妊娠率和术后第2年妊娠率比较,差异均无统计学意义(P>0.05);各组2年内总妊娠率比较,差异有统计学意义(P<0.05)。组间两两比较(采用Bonferroni方法调整α水平,α’=0.0038),中西药组的总妊娠率明显高于对照组,差异有统计学意义(P<0.0038);而中药组和西药组的总妊娠率有高于对照组的趋势,但差异均无统计学意义(P>0.0038)。(4)在术后的治疗过程中,中药组、西药组、中西药组和对照组的不良反应发生率分别为3.03%、6.90%、4.65%和2.56%,各组患者的不良反应发生率比�Objective To observe the effect of Luoshi Endometriosis Formula(LEF)combined with gonadotropin releasing hormone agonist(GnRH-a)on the postoperative recurrence and pregnancy rate of patients with stageⅢ-Ⅳendometriosis classified by the scale of American Society for Reproductive Medicine(ASRM).Methods According to the postoperative management,a total of 144 patients with ASRM stageⅢ-Ⅳendometriosis confirmed by laparoscopy and postoperative pathology were divided into Chinese medicine group(33 cases),western medicine group(29 cases),combined group(43 cases),and control group(39 cases),and the number of infertility patients with fertility requirement in the above four groups was 31,26,40,30 respectively.All of the patients were given postoperative conventional treatment,and additionally,Chinese medicine group was given oral use of LEF,western medicine group was given subcutaneous injection of GnRH-a,the combined group was treated with LEF combined with GnRH-a,and the control group had no medication of LEF or GnRH-a.The treatment for the 4 groups lasted 3 months.The postoperative recurrence of endometriosis within 6 postoperative months and the pregnancy rate of patients with fertility requirement within postoperative 2 years were observed,and the clinical efficacy and safety in the 4 groups were also evaluated.Results(1)After treatment for3 months,the total effective rate of Chinese medicine group,western medicine group,combined group,and control group was 60.61%,55.17%,53.49%,48.72%respectively,and the intergroup comparison showed that the difference was insignificant(P>0.05).(2)The intergroup comparison showed that the difference of postoperative recurrence rate of endometriosis within 6 postoperative months was statistically significant(P<0.05).The pairwise comparison with Bonferroni method(α’=0.0038)showed that and the combined group had lower recurrence rate than the control group(P<0.0038),and the recurrence rate in Chinese medicine group and western medicine group showed a decreasing trend in compa

关 键 词：子宫内膜异位症 不孕 罗氏内异方 促性腺激素释放激素激动剂(GnRH-a) 复发率 妊娠率 

分 类 号：R271.9[医药卫生—中西医结合] R711.71[医药卫生—中医妇科学]