长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在子宫内膜异位症治疗中的应用效果

摘要
图/表
参考文献(22)
相关文章 (15)

全文: PDF (528 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在子宫内膜异位症（EMS）治疗中的应用效果。方法选择2014年1月~2016年12月中国石油天然气总公司中心医院择期行腹腔镜手术治疗的EMS患者69例为研究对象，根据术中冲洗方法不同将其分为两组，对照组34例采用腹腔镜电凝烧灼术，术中以0.9%生理盐水1000 mL反复冲洗盆腔；研究组35例治疗方法同对照组，术中冲洗以0.9%生理盐水500 mL+20 mg地塞米松及0.9%生理盐水+曲普瑞林3.75 mg，先以生理盐水地塞米松灌洗液冲洗，再以曲普瑞林稀释液灌洗。观察两组患者术前及术后3、6、12个月时间痛经、盆腔痛及性交痛情况，炎性因子水平变化；术后随访1年，观察两组患者受孕、复发及不良反应情况。结果两组术后1、3 d炎性因子C反应蛋白（CRP）、白介素-6（IL-6）及肿瘤坏死因子-α（TNF-α）水平均低于同组术前（P < 0.05）；研究组术后1 d CRP、IL-6及TNF-α水平均低于同期对照组（P < 0.05）；两组术后3、6、12个月视觉模拟评分法（VAS）评分均低于同组治疗前（P < 0.05），研究组术后6、12个月VAS评分低于对照组同期（P < 0.05）；术后随访1年，研究组自然受孕率为65.71%，高于对照组的38.24%（P < 0.05），研究组复发率为2.86%，低于对照组的29.41%（P < 0.05），两组随访期间不良反应总发生率比较，差异无统计学意义（P > 0.05）。结论长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在治疗EMS中，可降低炎性因子水平及术后疼痛度，提高1年自然受孕率，值得临床推广。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	孟宪宁李红霞霍志平吴亚男王宏利郝媛媛

关键词 ：糖皮质激素, 促性腺激素释放激动剂, 腹腔镜, 术腔冲洗, 子宫内膜异位症

Abstract：Objective To explore the application effect of long acting glucocorticoid combined with gonadotropin releasing agonist laparoscopic irrigation in endometriosis (EMS). Methods From January 2014 to December 2016, 69 patients with EMS treated by laparoscopic surgery in Central Hospital of China National Petroleum Company were selected as the study objects. Patients were divided into two groups according to washing methods. Thirty-four cases in the control group, and laparoscopic electrocoagulation and cauterization were used to wash pelvic cavity repeatedly with 1000 mL of 0.9% physiological saline during operation. Thirty-five cases in the experimental group were treated with the same method as the control group. Intraoperative irrigation was done with 0.9 % saline 500 mL + 20 mg Dexamethasone and 0.9% saline + Triptorelin 3.75 mg, first with saline Dexamethasone lavage fluid, and then with Triptorelin diluent lavage. The changes of dysmenorrhea, pelvic pain, sexual intercourse pain and inflammatory factor levels in the two groups before and after operation for 3, 6 and 12 months were observed. All patients were followed up for 1 year after operation, and the pregnancy, recurrence and adverse reactions were observed. Results One day and three day after operation, the serum levels of C reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor (TNF-α) in the two groups were lower than those before operation(P < 0.05). One day after operation, the levels of CRP, IL-6, and TNF-α in the experimental group were lower than those of the control group (P < 0.05); the visual analogue score (VAS) scores at 3 and 12 months post operatively in both groups were lower than those before operation; and the 3, 6 and 12 months postoperatively were lower than those before the same group (P < 0.05), 6 and 12 month postoperative the VAS scores of the study group were lower than those of the control group(P < 0.05). The rate of spontaneous pregnancy in the experimental group was 65.71%, higher than that in the control group (38.24%, P < 0.05), and the recurrence rate in the study group was 2.86%, lower than that in the control group (29.41%, P < 0.05). During the one year of follow-up period, there was no significant difference in the total incidence of adverse reactions between the two groups (P > 0.05). Conclusion Glucocorticoid combined with gonadotropin-releasing hormone agonist laparoscopic surgical cavity rinse in the treatment of EMS can reduce the levels of inflammatory factors and the degree of postoperative pain, improve the one year natural pregnancy rate, and it is worthy of clinical promotion.

Key words： Glucocorticoid Gonadotropin-releasing hormone agonist Laparoscope Cavity irrigation Endometriosis

基金资助:河北省廊坊市科学技术研究与发展计划项目（2017013145）。

通讯作者: 李红霞（1970.5-），女，硕士，副主任医师，中国石油天然气集团公司中心医院妇产科科主任；研究方向：妇科肿瘤。

引用本文:

孟宪宁李红霞霍志平吴亚男王宏利郝媛媛. 长效糖皮质激素联合促性腺激素释放激动剂腹腔镜术腔冲洗在子宫内膜异位症治疗中的应用效果[J]. 中国医药导报, 2018, 15(29): 74-78.
MENG Xianning LI Hongxia HUO Zhiping WU Ya′nan WANG Hongli HAO Yuanyuan. Effect of long acting glucocorticoid combined with gonadotropin-releasing agonist laparoscopic irrigation in the treatment of endometriosis. 中国医药导报, 2018, 15(29): 74-78.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I29/74

[1] Gong L，Zhang S，Han Y，et al. Initiation of GnRH agonist treatment on 3-5 days postoperatively in endometriosis patients：a randomized controlled trial [J]. J Clin Pharmacol，2015，55（8）：848-853.
[2] Ballester M，Dehan P，Béliard A，et al. Role of genetic and environmental factors in the development of endometriosis [J]. Rev Med Liege，2012，67（5-6）：374-380.
[3] Vercellini P，Viganò P，Somigliana E，et al. Endometriosis：pathogenesis and treatment [J]. Nat Rev Endocrinol，2014， 10（5）：261-275.
[4] 刘颂平，温坚，殷新明.子宫内膜异位症患者腹腔冲洗液及血清CD133、ABCG2的表达[J].中国医药导报，2013， 10（24）：45-47.
[5] 皮洁，洛若愚，贾胜楠，等.不同药物治疗腹腔镜术后子宫内膜异位合并不孕的效果观察[J].中国妇幼保健，2016， 31（3）：639-641.
[6] Li Z，Zhang HY，Zhu YJ，et al． A randomized study comparing the side effects and hormonal status of Triptorelin and leuprorelin following conservative laparoscopic surgery for ovarian endometriosis in Chinese women [J]. Eur J Obstet Gynecol Reprod Biol，2014，2（183）：164-168．
[7] 薛娟，张媛媛，袁秀红，等.促性腺激素释放激素激动剂与维生素E对子宫内膜异位症不孕患者血清TNF-α及IL-6水平的影响[J].现代生物医学进展，2016，16（31）：6155-6157.
[8] Strowitzki T，Marr J，Gerlinger C，et al. Detailed analysis of a randomized，multicenter，comparative trial of dienogest versus leuprolide acetate in endometriosis[J]. Int J Gynaecol Obstet，2012，117（3）：228-233.
[9] 胡茜，刘兴琼，魏璐，等.腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效观察[J].现代生物医学进展，2016，16（25）：4899-4901，4882.
[10] Granese R，Perino A，Calagna G，et al. Gonadotrophin-releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis：a multi-center randomized trial [J]. Acta Obstet Gynecol Scand，2015 ，94（6）：637-645.
[11] Du XH，Liu JQ，Xin K，et al. Dexamethasone and sodium carboxymethyl cellulose prevent postoperative intraperitoneal adhesions in rats[J]. Braz J Med Biol Res，2015， 48（4）：344-348.
[12] 潘伟，俞磊.促性腺激素释放激素激动剂联合孕三烯酮在子宫内膜异位症腹腔镜术后的临床应用[J].中国临床研究，2016，29（4）：549-551.
[13] 冯彦娜，肖雁冰.腹腔镜手术联合醋酸曲普瑞林治疗子宫内膜异位合并不孕症的疗效观察[J].中国性科学，2016，25（9）：95-98.
[14] Divasta AD，Feldman HA，Gallagher JS，et al. Hormonal Add-Back Therapy for Females Treated With Gonadotropin-Releasing Hormone Agonist for Endometriosis：A Randomized Controlled Trial [J]. Obstet Gynecol，2015，126（3）：617-627.
[15] 冯子豪，蒋苹，韩雪松，等.腹腔镜手术联合地塞米松术腔冲洗治疗子宫内膜异位症的疗效观察[J].昆明医科大学学报，2016，37（3）：96-99.
[16] Ercan CM，Kayaalp O，Cengiz M，et al. Comparison of efficacy of bromocriptine and cabergoline to GnRH agonist in a rat endometriosis mode [J]. Arch Gynecol Obstet，2015，291（5）：1103-1111.
[17] 王越凤，刘高焰，陈涛.激素反添加法在 GnRHa治疗 EMS中的疗效及安全性[J].中国妇幼健康研究，2016， 27（6）：748-751.
[18] Jeng CJ，Chuang L，Shen J. A comparison of progestogens or oral contraceptives and gonadotropin-releasing hormone agonists for the treatment of endometriosis：a systematic review [J]. Expert Opin Pharmacother，2014， 15（6）：767-773.
[19] 向亚利，毛平.腹腔镜下个体化手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症75例疗效观察[J].中国内镜杂志，2015，21（1）：59-61.
[20] 莫如冰，黄少雅，关棱.GnRH-a与反向添加疗法联合治疗子宫内膜异位症的效果观察及安全性分析[J].中国医学创新，2017，14（19）：45-48.
[21] 李石，金素芳，马文君.腹腔镜手术联合GnRH-a治疗子宫内膜异位症伴不孕患者的疗效分析[J].中国医学创新，2018，15（7）：21-24.
[22] Angioni S，Pontis A，Cela V，et al. Surgical technique of endometrioma excision impacts on the ovarian reserve. Single-port access laparoscopy versus multiport access laparoscopy：a case control study [J]. Gynecol Endocrinol，2015，31（6）：454-457.