摘要
目的比较地诺孕素(DNG)与促性腺激素释放激素激动剂(GnRH-a)联合替勃龙反向添加在子宫腺肌病保守手术后的应用效果。方法选择2020年3月至2021年3月于新乡医学院第一附属医院行腹腔镜下子宫腺肌病病灶切除术的100例患者为研究对象,根据术后应用的药物将患者分为观察组和对照组,每组50例。2组患者均于静脉复合全身麻醉下行腹腔镜下子宫腺肌病病灶切除术。对照组患者于术后2 d内给予GnRH-a制剂亮丙瑞林缓释微球3.75 mg,皮下注射,28 d注射1次,共注射6次;于GnRH-a第2次注射日开始,给予替勃龙片2.5 mg,口服,每日1次,连续用药至最后1次注射亮丙瑞林缓释微球后28 d停药。观察组患者于术后2 d内开始给予DNG 2.0 mg,每日1次,口服,连续用药6个月。分别于治疗前、后,采用疼痛视觉模拟评分表(VAS)评估2组患者痛经的疼痛程度;采集患者空腹肘静脉血,使用全自动电化学发光免疫分析仪检测血清糖类抗原125(CA125)、雌二醇(E_(2))水平;采用月经失血图评分法(PBAC)评估2组患者月经量。观察2组患者治疗期间潮热出汗、不规则阴道流血、失眠烦躁、肌肉骨关节疼痛等药物相关不良反应的发生情况,评估2组患者治疗后的临床治疗效果。结果对照组患者显效30例,有效18例,无效2例,总有效率为96.0%(48/50);观察组患者显效27例,有效19例,无效4例,总有效率为92.0%(46/50);2组患者总有效率比较差异无统计学意义(χ^(2)=0.709,P>0.05)。治疗前、后,2组患者的VAS、PBAC评分及血清E_(2)、CA125水平比较差异无统计学意义(P>0.05)。2组患者治疗后的VAS、PBAC评分及血清E_(2)、CA125水平显著低于治疗前(P<0.01)。治疗期间,对照组患者发生潮热出汗8例(16.0%),不规则阴道流血2例(4.0%),失眠烦躁6例(12.0%),肌肉骨关节疼痛5例(10.0%);观察组患者发生潮热出汗6例(12.0%),不规则阴道流血13例(26.0%),失眠烦躁7例(14.0%),肌肉骨关节疼痛6例(12.0%);观察组患者不规则阴道流血发生率显著高于对照组(χ^(2)=0.002,P<0.05);2组患者潮热出汗、失眠烦躁、肌肉骨关节疼痛发生率比较差异无统计学意义(χ^(2)=0.564、0.766、0.749,P>0.05)。结论子宫腺肌病患者保守手术后,应用DNG与GnRH-a联合替勃龙反向添加疗法的临床效果相当,DNG治疗便捷性更高,更有利于提高患者的治疗依从性,可作为子宫腺肌病患者保守手术后的良好选择。
Objective To compare the application efficacy of dienogest(DNG)and gonadotropin releasing hormone agonist(GnRH-a)combined with reverse addition of tibolone after the conservative surgery of adenomyosis.Methods A total of 100 patients who underwent laparoscopic resection of adenomyosis focus in the First Affiliated Hospital of Xinxiang Medical University from March 2020 to March 2021 were selected as the research objects.According to the drugs used after surgery,the patients were divided into observation group and control group,with 50 cases in each group.The patients in the both groups underwent laparoscopic resection of adenomyosis focus under intravenous combined general anesthesia.The patients in the control group received a subcutaneous injection of 3.75 mg of GnRH-a formulation leuprorelin sustained-release microspheres within 2 days after surgery,with one injection every 28 days,a total of 6 injections;on the second injection day of GnRH-a,2.5 mg of tibolone tablets were administered orally,once a day,continuously took drug until 28 days after the last injection of leuprorelin sustained-release microspheres.The patients in the observation group were given 2.0 mg of DNG orally within 2 days after surgery,once a day for 6 months.Before and after treatment,the severity of dysmenorrhea of patients in the two groups were evaluated by using visual analog scale(VAS);the fasting elbow vein blood was collected from patients,and the serum carbohydrate antigen 125(CA125)and estradiol(E_(2))levels were detected by fully automatic electrochemical luminescence immunoassay analyzer;and the menstrual blood volumes of patients in the two groups were evaluated by using the psychological blood loss assessment chart(PBAC).The incidence of drug-related adverse reactions such as hot flushing and sweating,irregular vaginal bleeding,insomnia and irritability and muscle,bone and joint pain of patients during treatment in the two groups were observed.After treatment,the clinical efficacy of patients in the two groups was evaluated.Results In the control group,30 cases were excellent,18 cases were effective,2 cases were ineffective,and the total effective rate was 96.0%(48/50);in the observation group,27 cases were excellent,19 cases were effective,4 cases were ineffective,and the total effective rate was 92.0%(46/50).There was no significant difference in the total effective rate of patients between the two groups(χ^(2)=0.709,P>0.05).There was no significant difference in VAS,PBAC scores and serum E_(2),CA125 levels of patients between the two groups before and after treatment(P>0.05).The VAS,PBAC scores and serum E_(2) and CA125 levels of patients after treatment were significantly lower than those before treatment in the two groups(P<0.01).During treatment,8 patients(16.0%)had hot flushing and sweating,2 patients(4.0%)had irregular vaginal bleeding,6 patients(12.0%)had insomnia and irritability,and 5 patients(10.0%)had muscle,bone and joint pain in the control group;in the observation group,6 patients(12.0%)had hot flushing and sweating,13 patients(26.0%)had irregular vaginal bleeding,7 patients(14.0%)had insomnia and irritability,and 6 patients(12.0%)had muscle,bone and joint pain.The incidence of irregular vaginal bleeding of patients in the observation group was significantly higher than that in the control group(χ^(2)=0.002,P>0.05);there was no significant difference in the incidences of hot flushing and sweating,insomnia and irritability and muscle,bone and joint pain of patients between the two groups(χ^(2)=0.564,0.766,0.749;P>0.05).Conclusion The clinical effect of DNG is comparable to that of GnRH-a combined with tibolone reverse addition therapy in patients with adenomyosis after conservative surgery,DNG therapy is more convenient,and it is more beneficial to improve patients′treatment compliance,so it can be used as a good choice for patients with adenomyosis after conservative surgery.
作者
吴霏霏
杨君
许鑫
WU Feifei;YANG Jun;XU Xin(Department of Gynecology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《新乡医学院学报》
CAS
2023年第9期834-839,共6页
Journal of Xinxiang Medical University
基金
河南省科技厅科技发展计划项目(编号:192102310068)。
