子宫内膜异位症术后GnRH-a联合地诺孕素序贯治疗的近期疗效  

Short-term effectiveness of gonadotropin-releasing hormone agonist combined with dienogest sequential therapy after endometriosis surgery

作　　者：孙娟 张春花[2] 刘英 傅雪淑 SUN Juan;ZHANG Chunhua;LIU Ying;FU Xueshu(Department of Gynecology and Obstetrics,the Fourth People′s Hospital of Huai′an,Huai′an,Jiangsu 223300,China;Department of Gynecology,Huai′an Maternal and Child Health Care Hospital,Huai′an,Jiangsu 223300)

机构地区：[1]淮安市第四人民医院妇产科,江苏淮安223300 [2]淮安市妇幼保健院妇科,江苏淮安223300

出　　处：《徐州医科大学学报》2023年第6期410-414,共5页Journal of Xuzhou Medical University

基　　金：江苏省妇幼健康科研立项项目(F202141)。

摘　　要：目的比较子宫内膜异位症术后促性腺激素释放激素激动剂(GnRH-a)联合地诺孕素(DNG)序贯治疗与单用地诺孕素、单用GnRH-a治疗的近期疗效。方法选择2019年10月—2022年4月淮安市妇幼保健院确诊并行腹腔镜手术治疗的171例子宫内膜异位症患者作为研究对象,根据随机数字表分为3组,57例术后单用地诺孕素治疗(DNG组),57例术后单用GnRH-a治疗(GnRH-a组),57例术后采用GnRH-a联合地诺孕素序贯治疗(GnRH-a+DNG组)。比较术后6个月、1年患者治疗效果、不良反应、生活质量的差异。结果术后6个月、1年,3组患者治疗有效率、视觉模拟评分(VAS)差异均无统计学意义(P均>0.05)。术后1年,GnRH-a+DNG组复发率低于DNG组与GnRH-a组,差异均有统计学意义(P均<0.05)。术后6个月、1年,GnRH-a+DNG组与DNG组Kupperman评分低于GnRH-a组,差异均有统计学意义(P均<0.05);术后6个月、1年,GnRH-a+DNG组与DNG组腰椎骨密度(L-BMD)水平高于GnRH-a组,差异均有统计学意义(P均<0.05);术后1年,GnRH-a+DNG组与GnRH-a组阴道出血率低于DNG组,差异均有统计学意义(P均<0.05)。术后6个月、1年,GnRH-a+DNG组子宫内膜异位症健康量表(EHP-30)评分低于DNG组与GnRH-a组,差异均有统计学意义(P均<0.05)。结论GnRH-a联合地诺孕素序贯治疗模式可以降低子宫内膜异位症患者术后1年内复发率,改善阴道出血模式,减轻绝经症状与骨质疏松,提高生活质量。Objective To compare the short-term effectiveness of gonadotropin-releasing hormone agonist(GnRH-a)combined with dienogest(DNG)sequential therapy versus DNG alone and GnRH-a alone after endometriosis surgery.Methods A total of 171 endometriosis patients who were admitted to Huai′an Maternal and Child Health Care Hospital and underwent laparoscopy from October 2019 to April 2022 were enrolled.According to the random number table method,they were randomly divided into three groups(n=57):a DNG group(where patients were treated with DNG alone),a GnRH-a group(where patients were treated with GnRH-a alone)and a GnRH-a+DNG group(where both GnRH-a and DNG sequential therapy were used).Then,their clinical effectiveness,adverse reactions,and quality of life at postoperative 6 months and 1 year were compared.Results There were no statistical differences in therapeutic effect and Visual Analogue Scale(VAS)score among the three groups at postoperative 6 months and 1 year(all P>0.05).The recurrence rate in the GnRH-a+DNG group was significantly lower than those in the DNG group and the GnRH-a groups at postoperative 1 year(all P<0.05).Both the GnRH-a+DNG group and the DNG group showed significantly lower Kupperman scores than the GnRH-a group at postoperative 6 months and 1 year(all P<0.05).Both the GnRH-a+DNG group and the DNG group presented significantly lower lumbar bone mineral density(L-BMD)levels than the GnRH-a group at postoperative 6 months and 1 year(all P<0.05).Both the GnRH-a+DNG group and the GnRH-a group showed significant decreases in the vaginal bleeding rate at postoperative 1 year(all P<0.05).The Endometriosis Health Profile-30(EHP-30)score in the GnRH-a+DNG group was significantly lower than those in the DNG group and the GnRH-a group at postoperative 6 months and 1 year(all P<0.05).Conclusions The combination of GnRH-a and DNG sequential therapy can reduce the recurrence rate of endometriosis patients at postoperative 1 year,improve vaginal bleeding patterns,relieve menopausal symptoms and osteoporosis,a

关 键 词：子宫内膜异位症 腹腔镜 地诺孕素 促性腺激素释放激素激动剂 联合序贯治疗 

分 类 号：R713.1[医药卫生—妇产科学]