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目的探究Ⅲ~Ⅳ期子宫内膜异位症(EMT)保守术后应用促性腺激素释放激素激动剂(Gn RH-a)联合戊酸雌二醇或替勃龙反向添加方案的临床效果。方法回顾性分析腹腔镜保留生育功能手术后Ⅲ~Ⅳ期EMT且应用Gn RH-a治疗的88例患者,按照反向添加药物分为Gn RH-a+戊酸雌二醇组(Gn RH-a+E组)、Gn RH-a+替勃龙组(Gn RH-a+T组)和Gn RH-a组(对照组)。分析其效果、不良反应和术后1年复发率。结果 Gn RH-a+E组与Gn RH-a+T组更年期生活质量评分表(MRS)评分均低于对照组(P<0.05),且雌二醇(E2)水平高于对照组(P<0.05);两组潮热出汗的发生率明显低于对照组(P<0.05);三组患者术后1年内复发率比较,差异无统计学意义(P>0.05);Gn RH-a+E组与Gn RH-a+T组疼痛视觉模拟评分(VAS)评分、MRS评分、E2水平、不良反应和术后1年内复发率比较,差异均无统计学意义(P>0.05)。结论Ⅲ~Ⅳ期子宫内膜异位症保守术后应用Gn RH-a联合戊酸雌二醇或替勃龙的反向添加方案不影响Gn RH-a的治疗效果,具有相似的临床效果及安全性。
Objective To investigate the clinical effects of Gn RH-a combined with reverse addition of estradiol valerate or tibolone in patients with stage Ⅲ ~ Ⅳ endometriosis (EMT) after conservative treatment. Methods Eighty-eight patients with stage III-IV EMT who had retained reproductive function after laparoscopic surgery and were treated with Gn RH-a were randomly divided into Gn RH-a + estradiol valerate group (Gn RH-a + E group), Gn RH-a + tibolone group (Gn RH-a + T group) and Gn RH-a group (control group). Analysis of its effects, adverse reactions and recurrence rate after 1 year. Results The scores of menopausal quality of life in Gn RH-a + E group and Gn RH-a + T group were lower than those in control group (P <0.05), and estradiol (E2) <0.05). The incidence of hot flashes in both groups was significantly lower than that in the control group (P <0.05). There was no significant difference in relapse rate among the three groups within one year after operation (P> 0.05) The pain visual analogue scale (VAS) score, MRS score, E2 level, adverse reaction and relapse rate within 1 year after operation in group E and Gn RH-a + T had no statistical significance (P> 0.05). CONCLUSION: The reverse addition of Gn RH-a combined with estradiol valerate or tibolone in patients with stage III-IV endometriosis after conservative treatment does not affect the therapeutic effect of Gn RH-a, and has similar clinical effects and safety.