保守性手术后促性腺激素释放激素激动剂联合反加疗法治疗中重度子宫内膜异位症的疗效观察

目的:探讨促性腺激素释放激素激动剂(GnRH-a)联合结合型雌激素(CEE)和安宫黄体酮(MPA)反加疗法用于中重度子宫内膜异位症保守性手术后巩固治疗的临床疗效及安全性。方法:将腹腔镜保守性手术后39例中重度子宫内膜异位症患者随机分为3组:反加组(13例)于术后皮下注射诺雷得3.6mg,每4周一次,连续6次,用药第4个月起加用倍美力0.625mg/d、安宫黄体酮5mg/d,连用3个月;单药组(14例)术后单用诺雷得治疗。对照组(12例)不用药物治疗。结果:反加组、单药组症状完全缓解率为92.3%、85.7%,显著高于对照组51%(P<0.01);治疗组累积复发率分别为7.1%、7.7%,显著低于对照组33.3%(P<0.01);单药组用药后血清黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)明显低于治疗前(P<0.01)。结论:GnRH-a联合倍美力、安宫黄体酮反加疗法在缓解低雌激素症状、减缓骨转换等是安全有效的。反加疗法能减轻GnRH-a的副作用而不影响其疗效。

Clinical study of efficacy of GnRH - a combined with add back therapy in the treatment of advanced endometrosis after conservative laparoscopic operation

Objective:To observe the therapeutic effects and safety of endocrine response of gonadotropin(hormone)-releasing hormone-analogue(GnRH-a)combined with conjugated equine estrogen(CEE)and medroxy progesterone acetate(MPA)in the treatment of advanced endometrosis after conservatived laparoscopic operation.Methods:39 cases of endometriosis patients were randomly divided into 3 groups:add back group(n=13)were treated with GnRH-a 3.6 mg by hypodermic injection of 6 doses,each given 4 weeks apart;CEE(0.625 mg/d)and MPA(5 mg/d)were used as add back therapy from 4 to 6 courses of treatment;GnRH-a alone group(n=14)were only treated with GnRH-a after conservative laparoscopic operation,the control group(n=14)were without drug treatment.Results:Compared to the control group,the symptomatic relief rate of the two drug-treatment groups were obviously increased while cumulative relapse frequencies were obviously decreased(P<0.01,respectively).The levels of LH,FSH,E2 of GnRH-a alone group were obviously decreased after than those before GnRH-a treatment.Conclusion:GnRH-a combined with CEE and MPA add-back therapy is an effective therapy in the treatment of advanced endometrosis after conservative laparoscopic operation.It could improve the symptom of hypoestrogenemia,decrease bone turn-over.It is an effective and safe agent in relieving side effects induced by GnRH-a.