黄润强　杨　帆　方彩云　熊平安　张春莲

1.湖北省十堰市太和医院（湖北医药学院附属医院）妇科2病区，湖北十堰442000；2.湖北省十堰市太和医院（湖北医药学院附属医院）中心手术室妇泌组，湖北十堰442000

重度卵巢型内异症腹腔镜术后辅助GnRH-a治疗的临床效果

黄润强1杨帆2方彩云1熊平安1张春莲1

1.湖北省十堰市太和医院（湖北医药学院附属医院）妇科2病区，湖北十堰442000；2.湖北省十堰市太和医院（湖北医药学院附属医院）中心手术室妇泌组，湖北十堰442000

目的探讨重度卵巢型子宫内膜异位症（OEM）腹腔镜保守性手术术后辅助促性腺激素释放激素激动剂（GnRH-a）治疗的临床效果。方法回顾性分析2008年1月～2012年1月在湖北省十堰市太和医院行腹腔镜保守性手术的298例重度OEM患者的临床资料。按照术后是否辅助药物治疗分为三组，GnRH-a组110例，孕三烯酮组84例，未用药组104例。所有患者均随访2年，观察术后缓解情况、复发率、有生育要求患者的妊娠情况以及用药不良反应。结果GnRH-a组、孕三烯酮组及未用药组的缓解率分别为94.5%、91.7%、74.0%，GnRH-a组及孕三烯酮组缓解率明显高于未用药组，差异均有统计学意义（χ2=4.723、4.182，均P<0.05）；GnRH-a组与孕三烯酮组比较差异无统计学意义（χ2=2.012，P>0.05）；随访2年，GnRH-a组、孕三烯酮组及未用药组术后复发率分别为6.4%、14.3%、29.8%，GnRH-a组明显低于孕三烯酮组和未用药组，差异有统计学意义（χ2=4.982、20.119，均P<0.05）；孕三烯酮组明显低于未用药组，差异有统计学意义（χ2=4.667，P<0.05）；GnRH-a组、孕三烯酮组及未用药组的自然妊娠率分别为40.0%，33.3%，25.0%；三组比较差异无统计学意义（P>0.05）。GnRH-a组潮热盗汗发生率明显高于孕三烯酮组，而阴道流血、痤疮和转氨酶升高发生明显低于孕三烯酮组，差异均有统计学意义（χ2=5.028、4.876、4.394、4.085，均P<0.05）。结论重度OEM腹腔镜保守性手术术后辅助GnRH-a治疗可提高治疗效果，降低术后复发率，且不良反应少，但不能提高自然妊娠率。

卵巢型内异症；腹腔镜；GnRH-a；疗效

［Abstract］Objective To investigate the clinical effect of laparoscopic surgery assisted gonadotropin-releasing hormone agonist（GnRH-a）in the treatment of the severe ovarian endometriosis（OEM）.Methods Clinical data of 298 patients with severe OEM received the laparoscopic conservative surgery from January 2008 to January 2012 in Taihe Hospital of Shiyan City were retrospectively analyzed.They were divided into three groups according to whether assisted the postoperative drug treatment：GnRH-a group（110 cases），gestrinone group（84 cases），and no-drug group（104 cases）. After followed-up for 2 years，the relief situation of pelvic pain，recurrence rate，pregnancies situation of the patients had fertility requirements and drug adverse reaction were observed and compared.Results The pelvic pain remission rate of the GnRH-a group，gestrinone group and no-drug group was 94.5%，91.7%，and 74.0%，respectively；the remission rate of the GnRH-a group and gestrinone group was obviously higher than that of no-drug group，the differences were statistically significant（χ2=4.723，4.182；all P< 0.05），while the GnRH-a group and gestrinone group had no statistically significant difference（χ2=2.012；P>2.012）；followed-up for 2 years，the recurrence rate of the GnRH-a group，gestrinone group and no-drug group was 6.4%，14.3%and 29.8%，respectively，the GnRH-a group was significantly lower than the gestrinone group and the no-drug group，the gestrinone groupwas lower than that of no-drug group，the differences were statistically significant（χ2=4.982，20.119，4.667；all P< 0.05）.The natural pregnancy rate of the GnRH-a group，gestrinone group and no-drug group was 40.0%，33.3%and 25.0%respectively；there was no statistically significant difference within the three groups（P>0.05）.The incidence of the tidal fever and night sweating of the GnRH-a group was higher than the gestrinone group，the incidence of the vaginal bleeding，acne and elevated aminotransferase was lower than those in the gestrinone group，the differences were statistically significant（χ2=5.028，4.876，4.394，4.085；all P<0.05）.Conclusion The laparoscopic conservative surgery assisted GnRH-a in the treatment of the severe OEM can improve the treatment effect，reduce the postoperative recurrence rate，and has less adverse reaction，but cannot increase natural pregnancy rate.

［Key words］Ovarian endometriosis；Laparoscope；GnRH-a；Curative effect

子宫内膜异位症（Endometriosis，EMs）简称“内异症”，是育龄期女性常见病，卵巢型内异症（Ovarian endometriosis，OEM）是EMs的主要类型［1］。……