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目的探讨比较腹腔镜手术与促性腺激素释放激素激动剂(Gn RH-a)不同方式的联合应用对盆腔子宫内膜异位症(内异症)的疗效。方法 137例中、重度内异症患者,随机分为甲组(53例)、乙组(47例)和丙组(37例)。甲组患者术前术后各使用醋酸亮丙瑞林3个月;乙组患者直接行腹腔镜手术,根据术中情况术后使用醋酸亮丙瑞林3~6个月;丙组患者单纯行腹腔镜手术。比较三组术中情况及疗效。结果甲组手术时间、术后肛门排气时间均短于乙组和丙组,术中出血量少于乙组和丙组,差异具有统计学意义(P<0.05);乙组和丙组手术时间、术中出血量、术后肛门排气时间比较差异均无统计学意义(P>0.05)。术后随访1年,三组患者失访7例,随访率为94.89%。甲组和乙组治疗总有效率分别为96.23%、95.74%,均高于丙组的81.08%,差异具有统计学意义(P<0.05),甲、乙组两组治疗总有效率比较差异无统计学意义(P>0.05)。丙组无不良反应发生,甲组与乙组不良反应发生率均高于丙组,差异具有统计学意义(P<0.05),甲组与乙组不良反应发生率比较差异无统计学意义(P>0.05),多为用药期间潮热、盗汗和少量不规则阴道流血。甲组复发率均低于乙组和丙组,差异具有统计学意义(P<0.05)。结论术前使用Gn RH-a有利于手术的实施,腹腔镜手术联合使用Gn RH-a能有效抑制内异症复发。
Objective To investigate the effect of different combinations of laparoscopic surgery and gonadotropin-releasing hormone agonist (Gn RH-a) on pelvic endometriosis (endometriosis). Methods A total of 137 patients with severe endometriosis were randomly divided into group A (n = 53), group B (n = 47) and group C (n = 37). Group A patients before and after each use of leuprolide 3 months; Group B patients underwent laparoscopic surgery, according to the intraoperative postoperative use of leuprolide 3 to 6 months; Group C patients simply Laparoscopic surgery. Compare the three groups of intraoperative conditions and efficacy. Results The operation time of group A and the time of postoperative anal exhaust were shorter than those of group B and group C. The amount of bleeding during operation was less than that of group B and group C. The difference was statistically significant (P <0.05) Time, intraoperative blood loss, postoperative anal exhaust time was no significant difference (P> 0.05). After one year follow-up, seven patients lost to follow-up in three groups, the follow-up rate was 94.89%. The total effective rates of group A and group B were 96.23% and 95.74%, respectively, which were all higher than 81.08% of group C (P <0.05). There was no significant difference between the two groups Statistical significance (P> 0.05). There was no adverse reaction in group C, and the incidence of adverse reactions in group A and group B was higher than that in group C (P <0.05). There was no significant difference in the incidence of adverse reactions between group A and group B (P > 0.05), mostly during the hot flashes, night sweats and a small amount of irregular vaginal bleeding. The recurrence rate of group A was lower than that of group B and group C, the difference was statistically significant (P <0.05). Conclusions The preoperative use of Gn RH-a is helpful for the implementation of surgery. Laparoscopic surgery combined with Gn RH-a can effectively inhibit the recurrence of endometriosis.