地诺孕素与GnRH-a对卵巢子宫内膜异位囊肿术后疼痛和复发率的影响  

Effects of dienogest and GnRH-a on postoperative pain and recurrence rate of ovarian endometriosis cyst

作　　者：张秀玲 韩志红 戴旭 Zhang Xiuling;Han Zhihong;Dai Xu(Department of Obstetrics and Gynecology,XD Group Hospital,Xi'an 710077,China;Department of Gynecological Oncology,Shaanxi Provincial Cancer Hospital,Xi'an 710061,China)

机构地区：[1]西电集团医院妇产科,西安710077 [2]陕西省肿瘤医院妇瘤科,西安710061

出　　处：《国际医药卫生导报》2025年第1期26-30,共5页International Medicine and Health Guidance News

基　　金：陕西省自然科学基础研究计划(S2021-JC-YB-2216)。

摘　　要：目的比较卵巢子宫内膜异位囊肿(OEC)剔除术后辅以地诺孕素与促性腺激素释放激素激动剂(GnRH-a)治疗后患者疼痛和疾病复发率的差异。方法本研究为随机对照试验。依据随机硬币投掷法,将2020年5月至2022年4月西电集团医院妇产科符合OEC剔除术治疗标准的113例患者分为GnRH-a组(61例)和地诺组(52例)。GnRH-a组年龄(35.38±4.49)岁;病程(3.28±1.04)年;囊肿大小6.00(5.00,8.00)cm;美国生殖医学学会(American Society for Reproductive Medicine,ASRM)分期:Ⅰ~Ⅱ期30例,Ⅲ~Ⅳ期31例。地诺组年龄(35.52±4.61)岁;病程(3.52±1.06)年;囊肿大小6.00(5.00,8.00)cm;ASRM分期:Ⅰ~Ⅱ期26例,Ⅲ~Ⅳ期26例。从剔除术后首次月经来潮的第1天开始,GnRH-a组采用腹前壁皮下注射醋酸亮丙瑞林进行辅助治疗,3.75 mg/次,4周一次;地诺组口服地诺孕素片进行辅助治疗,2 mg/次,每天一次。两组均持续治疗24周。比较两组视觉模拟评分法(VAS)评分、不良反应、复发率和治疗满意度。采用独立样本t检验、非参数Wilcoxon检验、Mann-Whitney U检验、χ2检验进行统计学分析。结果用药24周后,地诺组痛经、慢性盆腔痛和性交痛VAS评分均低于GnRH-a组[0.50(0,2.00)分比1.00(0,3.00)分,1.00(0,3.00)分比2.00(1.00,4.00)分,0(0,2.00)分比1.00(0,2.00)分](Z=2.396、2.669、2.929,均P<0.05)。GnRH-a组和地诺组不良反应发生率和停药后12个月复发率比较[14.75%(9/61)比5.77%(3/52),8.20%(5/61)比1.92%(1/52)],差异均无统计学意义(χ2=2.378、2.197,均P>0.05)。地诺组治疗总满意度高于GnRH-a组[94.23%(49/52)比81.97%(50/61)](χ2=3.889,P<0.05)。结论相较于GnRH-a,OEC剔除术后辅以地诺孕素能有效缓解患者疼痛,预防疾病复发,获得更高的治疗满意度。Objective To compare the differences of pain and disease recurrence rates in patients after ovarian endometriosis cyst(OEC)excision treated with dienogest and gonadotropin-releasing hormone agonist(GnRH-a).Methods This study was a randomized controlled trial.According to the random coin toss method,113 patients who met the treatment criteria of OEC excision in the Department of Obstetrics and Gynecology of XD Group Hospital from May 2020 to April 2022 were divided into a GnRH-a group(61 cases)and a dienogest group(52 cases).The age of the GnRH-a group was(35.38±4.49)years old,the course of disease was(3.28±1.04)years,the cyst size was 6.00(5.00,8.00)cm,and the American Society for Reproductive Medicine(ASRM)staging was stageⅠtoⅡin 30 cases and stageⅢtoⅣin 31 cases.The age of the dienogest group was(35.52±4.61)years old,the course of disease was(3.52±1.06)years,the cyst size was 6.00(5.00,8.00)cm,and the ASRM staging was stageⅠtoⅡin 26 cases and stageⅢtoⅣin 26 cases.From the first day of the first menstrual period after OEC excision,the GnRH-a group was treated with subcutaneous injection of leuprelin acetate in the anterior abdominal wall,3.75 mg/time,once every 4 weeks;the dienogest group received oral dienogest tablets,2 mg/time,once a day.Both groups were treated for 24 weeks.The Visual Analogue Scale(VAS)score,adverse reactions,recurrence rate,and treatment satisfaction were compared between the two groups.Independent sample t test,non-parametric Wilcoxon test,Mann-Whitney U test,andχ^(2) test were used for statistical analysis.Results After 24 weeks of treatment,the VAS scores of dysmenorrhea,chronic pelvic pain,and sexual pain in the dienogest group were lower than those in the GnRH-a group[0.50(0,2.00)points vs.1.00(0,3.00)points,1.00(0,3.00)points vs.2.00(1.00,4.00)points,0(0,2.00)points vs.1.00(0,2.00)points](Z=2.396,2.669,and 2.929,all P<0.05).There was no statistically significant difference in the incidence of adverse reactions or the recurrence rate within 12 months after withdra

关 键 词：卵巢子宫内膜异位囊肿 剔除术 地诺孕素 促性腺激素释放激素激动剂 疼痛 复发 

分 类 号：R713[医药卫生—妇产科学]