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目的观察腹腔镜手术联合GnRH-a治疗子宫内膜异位症的效果。方法选择2015年1月—2016年2月收治的子宫内膜异位症患者80例,用随机数字表法将患者分为观察组、对照组各40例。两组均全麻下实施腹腔镜手术,观察组术后第1个月经周期第1天皮下注射GnRH-a 3.75 mg/次,1次/月,疗程为3个月。比较两组疗效,治疗前后检测两组卵泡刺激素(follicle stimulating hormone,FSH)、促黄体生成素(luteinizing hormone,LH)以及雌二醇(Estradiol,E_2),统计不良反应及复发率。计量资料比较采用t检验,计数资料比较用χ~2检验,P<0.05为差异有统计学意义。结果观察组总有效率(97.5%)显著高于对照组(82.5%),比较差异有统计学意义(P<0.05)。治疗后,两组FSH、LH、E_2水平均较治疗前[观察组(13.40±3.37)、(8.58±2.13)U/L、(184.64±39.71)μg/L;对照组(13.53±3.27)、(8.65±2.25)U/L、(184.83±40.32)μg/L]降低,比较差异有统计学意义(均P<0.05)。治疗后观察组FSH、LH、E_2[(6.57±2.03)、(3.84±1.17)U/L、(87.03±21.57)μg/L]水平与对照组[(11.34±2.97)、(8.07±2.10)U/L、(175.42±42.34)μg/L]比较差异有统计学意义(均P<0.05)。观察组不良反应发生率(10.0%)与对照组(7.5%)比较差异无统计学意义(P>0.05)。随访6个月,观察组复发复发率(2.5%)低于对照组(20.0%),比较差异有统计学意义(P<0.05)。结论腹腔镜手术联合GnRH-a治疗子宫内膜异位症临床疗效好,术后通过抑制卵巢分泌性激素并提高机体免疫力使残存的异位病灶萎缩退化,安全性高,术后复发率低。
Objective To observe the effect of laparoscopic surgery combined with GnRH-a in the treatment of endometriosis. Methods Eighty patients with endometriosis who were admitted from January 2015 to February 2016 were randomly divided into observation group (n = 40) and control group (n = 40) by random number table. Laparoscopic surgery was performed in both groups under general anesthesia. The observation group received subcutaneous injection of GnRH-a 3.75 mg / time on the first day after the first menstrual cycle. The course of treatment was 3 months. The effects of two groups were compared before and after treatment. The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E_2) were measured before and after treatment. The adverse reactions and relapse rates were statistically analyzed. Measurement data were compared using t test, count data were compared using χ ~ 2 test, P <0.05 for the difference was statistically significant. Results The total effective rate (97.5%) in observation group was significantly higher than that in control group (82.5%), the difference was statistically significant (P <0.05). After treatment, the levels of FSH, LH and E_2 in both groups were significantly higher than those before treatment [13.40 ± 3.37 vs 8.58 ± 2.13 U / L, (184.64 ± 39.71) μg / L vs 13.53 ± 3.27, (8.65 ± 2.25) U / L, (184.83 ± 40.32) μg / L], respectively. The difference was statistically significant (all P <0.05). After treatment, the levels of FSH, LH, E_2 [(6.57 ± 2.03), (3.84 ± 1.17) U / L and (87.03 ± 21.57) μg / L] in the observation group were significantly higher than those in the control group [(11.34 ± 2.97), (8.07 ± 2.10) U / L, (175.42 ± 42.34) μg / L], there was significant difference (all P <0.05). The incidence of adverse reactions in the observation group (10.0%) was not significantly different from that in the control group (7.5%) (P> 0.05). The follow-up of 6 months, the recurrence rate of recurrence in the observation group (2.5%) was lower than that in the control group (20.0%), the difference was statistically significant (P <0.05). Conclusions Laparoscopic surgery combined with GnRH-a has a good clinical efficacy in the treatment of endometriosis. Postoperatively, the residual ectopic lesion is atrophied and degenerated by inhibiting the secretion of ovarian hormones and enhancing the immunity of the body, which is safe and has a low recurrence rate.