摘要
目的研究反加疗法在腹腔镜双侧卵巢子宫内膜异位囊肿剥除术后联合促性腺激素释放激素激动剂(GnRH-α)治疗过程中的临床意义。方法选择2013年2月至2015年8月在江苏省苏北人民医院行腹腔镜双侧卵巢子宫内膜异位囊肿剥除术的患者83例,分为两组,A组48例为GnRH-α组,B组35例为GnRH-α+替勃龙组。检测A、B两组术前、术后3个月的血清雌二醇(E2)、促卵泡激素(FSH)和血清骨钙素(BGP)水平,并记录各组术后3个月改良Kupperman评分、疼痛视觉模拟(VAS)评分。结果 A、B两组组内比较,术后3个月的FSH、E2水平和术前相比均明显下降,差异有显著性(t值分别为4.21、5.07,均P<0.05);A组中年龄>35岁患者,术后3个月血清BGP水平和术前相比显著升高(t=3.81,P<0.05),年龄≤35岁的患者和术前相比变化不明显(t=0.81,P>0.05),B组中不同年龄段患者和术前相比均无明显差异(t值分别为0.76、0.62,均P>0.05)。A、B两组组间比较,术后3个月,血清E2水平B组明显高于A组(t=2.83,P<0.05);血清FSH水平A组明显高于B组(t=2.68,P<0.05);术后3个月,Kupperman评分A组显著高于B组(t=3.99,P<0.05);VAS两组相比差异无显著性(t=0.53,P>0.05)。结论腹腔镜双侧卵巢子宫内膜异位囊肿剥除术后联合GnRH-α治疗时,予以替勃龙反加治疗可以有效缓解使用GnRH-α引起的低雌激素症状、保护骨量,尤其对于年龄>35岁的患者,是一种安全、有效的治疗方案。
Objective To explore the clinical significance of add-back therapy in patients treated with gonadotrophin releasing hormone agonist （GnRH-α） after laparoscopic cystectomy of bilateral ovarian endometrioma cyst. Methods Eighty-three women who underwent laparoscopic cystectomy of bilateral ovarian endometrioma cyst in People＇s Hospital of North Jiangsu were selected and divided into two groups. Group A （48 cases） was GnRH-α group, and Group B （35 cases） was GnRH-α＋tibolone group. Serum estradiol （E2）, follicle stimulating hormone （FSH） and serum osteocalcin （BGP） levels in two groups were detected at 3 months before and after operation, and scores of improved Kupperman and viral analogue scale （VAS） in each group at 3 months after operation were recorded. Results FSH and serum E2 in both groups at 3 months after operation were significantly lower than those before surgery according to intra-group comparison in group A and B, and differences had significance （t = 4.21, Pal0.05; t = 5.07,P〈0.05）. Serum BGP increased obviously in patients with age 〉35 years at 3 months after surgery in group A compared with that before surgery （t=3.81, P〈0.05）, while serum BGP in patients with age ≤35 years had no obvious difference （t = 0.81, P〉0.05）. Serum BGP in patients at various ages in Group B at 3 months after surgery had no significant difference compared to that before surgery （t=0.76, P〉0.05; t=0.62, P〉0.05）. Serum E2 level in group B at 3 months after surgery was significantly higher than that in group A （t=2.83, P^0.05）. Serum FSH level in group A was significantly higher than that in group B at 3 months after surgery （t = 2.68, P〈0.05）. Kupperman score in group A was significantly higher than that in group B at 3 months after surgery （t=3.99,P〈0. 05）. VAS score in group A and B had no significant difference （t=0.53, P〉0.05）. Conclusion Tibolone add-back therapy for patients treated with GnRH-α after laparoscopic cystectomy of bilateral ovarian endometrioma cyst can relieve hypoestrogemic symptoms caused by GnRH-α and protect bone mass, especially for women over 35 years. It is a safe and effective treatment.
作者
苏悦
顾扬
黄永生
尹香花
SU Yue;GU Yang;HUANG Yong-sheng;YIN Xiang-hua(Department of Gynecology, People＇s Hospital of North Jiangsu, Jiangsu Yangzhou 225000, Chin)
出处
《中国妇幼健康研究》
2018年第4期514-518,共5页
Chinese Journal of Woman and Child Health Research
