Li T, Xu X X, Dai Y, Zhang J J, Lang J H, Leng J H
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 May 25;52(5):307-313. doi: 10.3760/cma.j.issn.0529-567X.2017.05.004.
To evaluate different postoperative medications as maintenance treatment for rectovaginal endometriosis (RVE) patients after conservative surgery. RVE patients who underwent transvaginal partial excision from January 2007 to September 2016 with regular outpatient follow-up were retrospectively screened. Those followed by a levonorgestrel-releasing intrauterine system (LNG-IUS) insertion or oral contraceptive drospirenone/ethinylestradiol (DRSP/EE) 3 mg/30 μg administration were enrolled. Variations in endometriosis-related pain, sexual function and quality of life were measured by visual analogue scale (VAS), female sexual function index (FSFI) and short form 36-item health survey (SF-36) respectively. There were a total of 102 RVE patients with 48 (47.1%, 48/102) in LNG-IUS group and 54 (52.9%, 54/102) in DRSP/EE group included. A rapid and marked improvement was observed after 3 months postoperative medical treatment compared to preoperative in both groups (<0.01). In dysmenorrhea, for LNG-IUS group (2.5±0.8) versus (7.6±1.3; <0.01), for DRSP/EE group (2.7±0.6) versus (7.7±1.4; <0.01); in FSFI, for LNG-IUS group (23.5±2.0) versus (21.0±2.7; <0.01), for DRSP/EE group (23.4±1.2) versus (21.5±2.2; <0.01); in SF-36, both groups had obvious improvements in physical component summary and mental component summary (<0.01), for LNG-IUS group (74±13) versus (56±19), (75±13) versus (55±17), for DRSP/EE group (73±11) versus (59±15), (75±9) versus (54±14). These effects were maintained stably and progressively during postoperative medication at 6-, 12-, 24-month follow up. Transvaginal partial excision combined postoperative LNG-IUS or DRSP/EE treatment is a safe and viable technique to alleviate pain, improve sexual function and quality of life.
评估不同术后药物作为保守性手术后直肠阴道子宫内膜异位症（RVE）患者的维持治疗。回顾性筛选2007年1月至2016年9月期间接受经阴道部分切除术并进行定期门诊随访的RVE患者。纳入那些随后接受左炔诺孕酮宫内节育系统（LNG-IUS）植入或口服避孕药屈螺酮/炔雌醇（DRSP/EE）3mg/30μg治疗的患者。分别通过视觉模拟量表（VAS）、女性性功能指数（FSFI）和36项简短健康调查（SF-36）来测量子宫内膜异位症相关疼痛、性功能和生活质量的变化。总共102例RVE患者，其中LNG-IUS组48例（47.1%，48/102），DRSP/EE组54例（52.9%，54/102）。与术前相比，两组术后3个月药物治疗后均观察到快速且显著的改善（<0.01）。在痛经方面，LNG-IUS组（2.5±0.8）对比（7.6±1.3；<0.01），DRSP/EE组（2.7±0.6）对比（7.7±1.4；<0.01）；在FSFI方面，LNG-IUS组（23.5±2.0）对比（21.0±2.7；<0.01），DRSP/EE组（23.4±1.2）对比（21.5±2.2；<0.01）；在SF-36方面，两组在身体成分总结和精神成分总结方面均有明显改善（<0.01），LNG-IUS组（74±13）对比（56±19），（75±13）对比（55±17），DRSP/EE组（73±11）对比（59±15），（75±9）对比（54±14）。在术后6个月、12个月、24个月随访的药物治疗期间，这些效果稳定且逐渐维持。经阴道部分切除联合术后LNG-IUS或DRSP/EE治疗是一种安全可行的技术，可减轻疼痛、改善性功能和生活质量。
