孟宪宁 李红霞 霍志平 吴亚男 王宏利 郝媛媛

[摘要] 目的 探討长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在子宫内膜异位症（EMS）治疗中的应用效果。 方法 选择2014年1月～2016年12月中国石油天然气总公司中心医院择期行腹腔镜手术治疗的EMS患者69例为研究对象，根据术中冲洗方法不同将其分为两组，对照组34例采用腹腔镜电凝烧灼术，术中以0.9%生理盐水1000 mL反复冲洗盆腔；研究组35例治疗方法同对照组，术中冲洗以0.9%生理盐水500 mL+20 mg地塞米松及0.9%生理盐水+曲普瑞林3.75 mg，先以生理盐水地塞米松灌洗液冲洗，再以曲普瑞林稀释液灌洗。观察两组患者术前及术后3、6、12个月时间痛经、盆腔痛及性交痛情况，炎性因子水平变化；术后随访1年，观察两组患者受孕、复发及不良反应情况。 结果 两组术后1、3 d炎性因子C反应蛋白（CRP）、白介素-6（IL-6）及肿瘤坏死因子-α（TNF-α）水平均低于同组术前（P < 0.05）；研究组术后1 d CRP、IL-6及TNF-α水平均低于同期对照组（P < 0.05）；两组术后3、6、12个月视觉模拟评分法（VAS）评分均低于同组治疗前（P < 0.05），研究组术后6、12个月VAS评分低于对照组同期（P < 0.05）；术后随访1年，研究组自然受孕率为65.71%，高于对照组的38.24%（P < 0.05），研究组复发率为2.86%，低于对照组的29.41%（P < 0.05），两组随访期间不良反应总发生率比较，差异无统计学意义（P > 0.05）。 结论 长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在治疗EMS中，可降低炎性因子水平及术后疼痛度，提高1年自然受孕率，值得临床推广。

[关键词] 糖皮质激素；促性腺激素释放激动剂；腹腔镜；术腔冲洗；子宫内膜异位症

[中图分类号] R711.71 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0074-05

[Abstract] Objective To explore the application effect of long acting glucocorticoid combined with gonadotropin releasing agonist laparoscopic irrigation in endometriosis （EMS）. Methods From January 2014 to December 2016， 69 patients with EMS treated by laparoscopic surgery in Central Hospital of China National Petroleum Company were selected as the study objects. Patients were divided into two groups according to washing methods. Thirty-four cases in the control group， and laparoscopic electrocoagulation and cauterization were used to wash pelvic cavity repeatedly with 1000 mL of 0.9% physiological saline during operation. Thirty-five cases in the experimental group were treated with the same method as the control group. Intraoperative irrigation was done with 0.9 % saline 500 mL + 20 mg Dexamethasone and 0.9% saline + Triptorelin 3.75 mg， first with saline Dexamethasone lavage fluid， and then with Triptorelin diluent lavage. The changes of dysmenorrhea， pelvic pain， sexual intercourse pain and inflammatory factor levels in the two groups before and after operation for 3， 6 and 12 months were observed. All patients were followed up for 1 year after operation， and the pregnancy， recurrence and adverse reactions were observed. Results One day and three day after operation， the serum levels of C reactive protein （CRP）， interleukin-6 （IL-6） and tumor necrosis factor （TNF-α） in the two groups were lower than those before operation（P < 0.05）. One day after operation， the levels of CRP， IL-6， and TNF-α in the experimental group were lower than those of the control group （P < 0.05）； the visual analogue score （VAS） scores at 3 and 12 months postoperatively in both groups were lower than those before operation； and the 3， 6 and 12 months postoperatively were lower than those before the same group （P < 0.05）， 6 and 12 month postoperative the VAS scores of the study group were lower than those of the control group（P < 0.05）. The rate of spontaneous pregnancy in the experimental group was 65.71%， higher than that in the control group （38.24%， P < 0.05）， and the recurrence rate in the study group was 2.86%， lower than that in the control group （29.41%， P < 0.05）. During the one year of follow-up period， there was no significant difference in the total incidence of adverse reactions between the two groups （P > 0.05）. Conclusion Glucocorticoid combined with gonadotropin-releasing hormone agonist laparoscopic surgical cavity rinse in the treatment of EMS can reduce the levels of inflammatory factors and the degree of postoperative pain， improve the one year natural pregnancy rate， and it is worthy of clinical promotion.

[Key words] Glucocorticoid； Gonadotropin-releasing hormone agonist； Laparoscope； Cavity irrigation； Endometriosis

子宫内膜异位症（endometriosis，EMS）简称“内异症”，是妇产科常见良性疾病，至今病因不明，目前多数学者认为是由于具有生长功能的子宫内膜侵袭子宫内膜以外其他部位引发，与环境、遗传、免疫及炎性反应等多因素有关，具有治愈率低下、复发率高的特点[1]。……