【摘要】 目的：比較不同药物结合手术治疗中重度子宫内膜异位症（endometriosis，EMs）伴不孕患者的效果。方法：选取2019年2-12月本院妇产科收治的86例EMs伴不孕患者，采用随机数字表法分成两组，每组43例。两组均行腹腔镜手术，术后分别予以孕三烯酮（对照组）、醋酸曲普瑞林（研究组），观察两组实验室指标、临床疗效，并随访妊娠率及复发率。结果：两组术前VAS评分、血清指标比较，差异均无统计学意义（P>0.05）;治疗结束，两组VAS评分、血清FSH、E2、AMH较术前均降低（P<0.05）;治疗结束，研究组VAS评分及血清FSH、E2均低于对照组，血清AMH高于对照组（P<0.05）;研究组总有效率为95.35%，明显高于对照组的79.07%（P<0.05）。研究组随访6、12个月累积自然妊娠率均明显高于对照组（67.44% vs 44.19%，86.05% vs 65.12%），差异均有统计学意义（P<0.05）。对照组复发率为23.53%（8/34），高于研究组的12.20%（5/41），但差异无统计学意义（P>0.05）。结论：中重度EMs伴不孕患者腹腔镜手术后应用GnRH-a与孕三烯酮，均能有效改善临床症状和激素分泌，但GnRH-a对患者的卵巢储备功能保护效果更突出，术后妊娠率提升更明显，更适合临床普遍推广。

【关键词】 孕三烯酮 醋酸曲普瑞林 子宫内膜异位症 不孕 卵巢储备功能

Effect of Different Drugs Combined with Surgery in the Treatment of Patients with Moderate to Severe Endometriosis with Infertility/XIE Zhenfang. //Medical Innovation of China， 2021， 18（34）： 0-096

[Abstract] Objective： To compare the effect of different drugs combined with surgery in the treatment of patients with moderate to severe endometriosis （EMs） with infertility. Method： A total of 86 patients with EMs with infertility admitted to the obstetrics and gynecology department of our hospital from February 2019 to December 2019 were selected， they were randomly divided into two groups by random number table method， 43 cases in each group. Two groups were given laparoscopic surgery， and Gestrinone （the control group） and Triptorelin Acetate （the study group） were given after operation. The laboratory indicators， clinical efficacy， and follow-up pregnancy rate and recurrence rate of two groups were observed. Result： There were no significant differences in the preoperative VAS scores and serum indexes between two groups （P>0.05）. At the end of treatment， the VAS score， serum FSH， E2 and AMH of two groups were lower than those of before operation （P<0.05）. At the end of treatment， the VAS score and serum FSH and E2 of the study group were lower than those of the control group， and the serum AMH was higher than that of the control group （P<0.05）. The total clinical effective rate of the study group was 95.35%， which was significantly higher than 79.07% of the control group， the difference was statistically significant （P<0.05）. The 6-month and 12-month follow-up pregnancy rates in the study group were significantly higher than those in the control group （67.44% vs 44.19%， 86.05% vs 65.12%）， and the differences were statistically significant （P<0.05）. The cumulative recurrence rate of the control group was 23.53% （8/34）， which was higher than 12.20% （5/41） of the study group， but there was no significant difference （P>0.05）. Conclusion： The application of GnRH-a and Gestrinone after laparoscopic surgery in patients with moderate to severe EMs and infertility can effectively improve clinical symptoms and hormone secretion， but GnRH-a has a more prominent protective effect on ovarian reserve function， and the postoperative pregnancy rate is increased more obviously， which is more suitable for general clinical promotion.

[Key words] Gestrinone Triptorelin Acetate Endometriosis Infertility Ovarian reserve

First-author’s address： Xiamen Xinkaiyuan Hospital， Xiamen 361000， China

doi：10.3969/j.issn.1674-4985.2021.34.022

子宫内膜异位症（EMs）为育龄期妇女常见妇科疾病，我国该病患病率达18%，其中合并不孕症患者达30%～40%，已成为导致女性不孕的重要原因之一，尤其中重度EMs患者预后较差[1-2]。腹腔镜手术是中重度EMs治疗的首选方法，可快速去除病灶，改善临床症状。但近年来研究发现，单纯腹腔镜手术无法完全清除深部病灶，术后随访复发率可达40%以上[3]。而术后联合应用药物治疗可显著降低术后复发率，改善妊娠结局[4]。……