醋酸甲羟孕酮联合左炔诺孕酮宫内节育系统对中重度子宫内膜异位症腹腔镜术后性激素血管内皮生长因子水平的影响  

Effects of medroxyprogesterone acetate combined with a levonorgestrel-releasing intrauterine contraceptive system on sex hormone and vascular endothelial growth factor levels after laparoscopic surgery for moderate and severe endometriosis

作　　者：朱玲 曾颖 曹娟 Zhu Ling;Zeng Ying;Cao Juan(Department of Obstetrics and Gynecology,Hangzhou Ninth People's Hospital,Hangzhou 311225,Zhejiang Province,China,Luqiao Hospital of Taizhou Enze Medical Center(Group),Taizhou 318050,Zhejiang Province,China;Department of Obstetrics and Gynecology,the 9,Luqiao Hospital of Taizhou Enze Medical Center(Group),Taizhou 318050,Zhejiang Province,China;Hospital of the Joint Service Forces of the Chinese People's Liberation Army,Hangzhou 310001,Zhejiang Province,China,Luqiao Hospital of Taizhou Enze Medical Center(Group),Taizhou 318050,Zhejiang Province,China)

机构地区：[1]杭州市第九人民医院妇产科,311225 [2]解放军联勤保障部队第九〇三医院妇产科,杭州310001 [3]台州恩泽医疗中心(集团)路桥医院检验科,浙江省318050

出　　处：《中国基层医药》2021年第11期1658-1662,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨醋酸甲羟孕酮联合左炔诺孕酮宫内节育系统(曼月乐)对中重度子宫内膜异位症患者腹腔镜术后性激素、血管内皮生长因子(VEGF)水平的影响。方法回顾性分析2015年10月至2018年5月于杭州市第九人民医院接受腹腔镜保守手术的子宫内膜异位症患者102例的治疗情况。按照治疗方式不同分为观察组和对照组,各51例。对照组在术后给予醋酸甲羟孕酮治疗,连续治疗6个月,观察组在对照组基础上联合曼月乐治疗。比较两组治疗后临床疗效、血清黄体生成素(LH)、卵泡雌激素(FSH)、雌二醇(E2)、VEGF、视觉模拟评分法(VAS)评分的变化及复发率、不良反应。结果观察组总有效率为94.12%(48/51),明显高于对照组的80.93%(41/51),差异有统计学意义(χ^(2)=4.320,P<0.05)。观察组治疗后6个月时,血清LH、FSH、E2、VEGF分别为(5.72±0.53)U/L、(5.05±0.91)U/L、(156.02±21.80)pmol/L、(155.39±24.72)ng/L,均明显低于对照组的(6.51±0.67)U/L、(5.73±0.68)U/L、(177.20±23.20)pmol/L、(186.22±28.14)ng/L,差异均有统计学意义(t=6.604、4.275、4.747、5.878,均P<0.05)。治疗后3个月、6个月时,观察组VAS评分分别为(2.39±0.33)分、(1.27±0.20)分,均明显低于对照组的(2.72±0.40)分、(1.52±0.25)分,差异均有统计学意义(t=4.545、5.577,均P<0.05)。随访2年结果显示,观察组复发率为1.96%(1/51),明显低于对照组的13.73%(7/51)(χ^(2)=4.883,P<0.05)。观察组和对照组不良反应总发生率分别为15.69%(8/51)和13.73%(7/51),差异无统计学意义(χ^(2)=0.078,P>0.05)。结论醋酸甲羟孕酮联合曼月乐在中重度子宫内膜异位症腹腔镜术后应用效果明显,可有效调节血清性激素、VEGF水平,降低复发率,且安全性好,值得应用推广。Objective To investigate the effects of medroxyprogesterone acetate combined with a levonorgestrel-releasing intrauterine contraceptive system(Mirena)on the levels of sex hormone and vascular endothelial growth factor in patients with moderate and severe endometriosis after laparoscopic surgery.Methods A total of 102 patients with endometriosis who received laparoscopic conservative surgery in Hangzhou Ninth People's Hospital from October 2015 to May 2018 were retrospectively analyzed.They were randomly assigned to undergo either medroxyprogesterone acetate treatment alone(control group,n=51)or medroxyprogesterone acetate treatment+levonorgestrel-releasing intrauterine contraceptive system application(observation group,n=51)for 6 successive months.Clinical efficacy,serum luteinizing hormone,follicle-stimulating hormone,estradiol and vascular endothelial growth factor levels,Visual Analogue Scale score,endometriosis recurrence rate,and adverse reactions were compared between the control and observation groups.Results Total effective rate in the observation group was significantly higher than that in the control group[94.12%(48/51)vs.80.93%(41/51),χ^(2)=4.320,P<0.05].At 6 months after surgery,serum luteinizing hormone,follicle-stimulating hormone,estradiol and vascular endothelial growth factor levels in the observation group were(5.72±0.53)U/L,(5.05±0.91)U/L,(156.02±21.80)pmol/L and(155.39±24.72)ng/L respectively,which were significantly lower than those in the control group[(6.51±0.67)U/L,(5.73±0.68)U/L,(177.20±23.20)pmol/L and(186.22±28.14)ng/L,t=6.604,4.275,4.747 and 5.878,all P<0.05].At 3 and 6 months after surgery,Visual Analogue Scale score in the observation group were(2.39±0.33)points and(1.27±0.20)points respectively,which were significantly lower than those in the control group[(2.72±0.40)points,(1.52±0.25)points,t=4.545 and 5.577,both P<0.05].Two-year follow-up results revealed that endometriosis recurrence in the observation group was significantly lower than that in the control group[1.96

关 键 词：子宫内膜异位症 腹腔镜检查 醋酸甲羟孕酮 左炔诺孕酮 宫内避孕器 血管内皮生长因子类 性腺激素类 安全 

分 类 号：R713.4[医药卫生—妇产科学]