国际妇产科学杂志

国际妇产科学杂志 ›› 2013, Vol. 40 ›› Issue (1): 75-76.

• 论著 • 上一篇    下一篇

GnRHa联合反加疗法用于腹腔镜术后子宫内膜异位症的临床观察

范宝光 , 任琛琛   

  1. 450052 郑州大学第三附属医院妇产科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2013-02-15 发布日期:2013-02-15
  • 通讯作者: 任琛琛

Clinical Observation of Efficacy of GnRHa Combined with Add Back Therapy in the Treatment of Advanced Endometriosis After Laparoscopic Operation

FAN Bao-guang，REN Chen-chen   

  1. Obstetrics and Gynecology of the Third Affiliated Hospital of Zhengzhou University，Zhenzhou 450052，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2013-02-15 Online:2013-02-15
  • Contact: REN Chen-chen

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摘要： 目的：探讨促性腺激素释放激素激动剂（GnRHa）联合结合型雌激素（CEE）及醋酸甲羟孕酮（MPA）用于子宫内膜异位症手术后巩固治疗的临床效果及安全性。方法：将96例腹腔镜术后子宫内膜异位症患者随机分成3组：单药组（33例）：于术后皮下注射曲普瑞林3.75 mg，每28 d 1次，连用6个周期；反加组（32例）于术后皮下注射曲普瑞林3.75 mg，每28 d 1次，连用6个周期，自用药第4个周期起开始反加疗法，即加用结合型雌激素0.625 mg/d，醋酸甲羟孕酮5 mg/d，连用3个周期；对照组（31例）：术后拒用药物治疗（因价格昂贵）。结果：单药组、反加组临床症状完全缓解率分别为90.9%和93.8%，均高于对照组（48.4%，P ＜0.01）；单药组、反加组累计复发率分别为3.0%和6.2%，均低于对照组的（33.3%，P ＜0.01）；治疗后单药组与反加组患者的血清雌二醇（E2）、卵泡刺激素（FSH）、黄体生成激素（LH）均低于对照组，差异有统计学意义（P ＜0.05），治疗后单药组患者的E2水平明显低于反加组（P ＜0.05），差异有统计学意义。结论：GnRHa联合结合型雌激素及醋酸甲羟孕酮反加疗法对控制低雌激素症状安全有效。反加疗法能减少GnRHa的不良反应且不影响其疗效。

关键词: 腹腔镜检查, 子宫内膜异位症, 促性腺素释放激素, 曲普瑞林, 雌激素类, 临床方案

Abstract: Objective: To observe the therapeutic effects and safety of endocrine response of gonadotropin（hormone）- releasing hormone-analogue （GnRHa） combined with conjugated estrogen （CEE） and medroxyprogesterone acetate （MPA） in the treatment of advanced endometriosis after laparoscopic operation. Methods: Ninety-six cases of endometriosis after laparoscopic. Patients were randomly divided into three groups， single-agent group（33 cases）: in postoperative subcutaneous injection of triptorelin 3.75 mg， once every 4 weeks for 6 times; anti-plus group（32 cases）: after subcutaneous injection of triptorelinin 3.75 mg， once every 4 weeks for 6 times， since the fourth injection， we add conjugated estrogens 0.625 mg/d with medroxyprogesterone acetate 5 mg/d for 3 months; the control group （31 cases） without drug treatment. Results: Complete remission rate of clinical symptoms in single-agent group and add-back group was 90.9% and 93.8% respectively， significantly higher than 48.4% in control group（P ＜0.01）；cumulative relapse rates in single-agent group and add-back group were 3.0% and 6.2%，significantly lower than 33.3% in the control group（P ＜0.01）；the serum E2，FSH，LH concentration in single-agent group after treatment was significantly lower than that before treatment（P ＜0.01）. Conclusions: GnRHa combined with conjugated estrogen and medroxyprogesterone acetate is safe and effective in the control of low estrogen symptoms， reduce bone turnover， etc. Add-back therapy can reduce the side effects of GnRHa with unaffectting its efficacy.

Key words: Laparoscopy, Endometriosis, Gonadotropin-releasing hormone, Triptorelin, Estrogens, Clinical protocols