Nikitina Iryna M, Boiko Volodymyr I, Smiian Svitlana A, Babar Tetiana V, Kalashnyk Natalia V, Boiko Alesia V, Іkonopystseva Natalia А, Bolotna Maryna A
Sumy State University, Sumy, Ukraine.
Wiad Lek. 2020;73(5):868-872.
The aim: The aim of the study was to improve the results of treatment of patients with endometriosis by using a combination method of therapy.
Materials and methods: For two years, 136 women of reproductive age who underwent laparoscopic surgeries for ovarian endometriosis were monitored: Group I (n = 24) did not receive any hormonal treatment in the perioperative period; Group II (n = 32) - received gonadotropin-releasing hormone agonists within 3 months after surgery; Group III (n = 80) prior to laparoscopic removal of the ovarian cyst used gonadotropin-releasing hormone agonists - Triptorelin 3.75 mg intramuscularly for 2 months, as well as three months after surgery. The control group consisted of 30 healthy women of reproductive age with regular menstrual periods. All patients underwent transvaginal ultrasound, counting the number of antral follicles before and after treatment. Serum hormone levels (FSH, prolactin, thyrotropic hormone, anti-Mullerian hormone, inhibin B) were determined by enzyme-linked immunosorbent assay on Cobas e-411 analyzer (Roche Diagnostics, Switzerland) on day 2-3 of the menstrual cycle and on day 2-3 of the first menstrual period after the end of treatment. Laparoscopic removal of the cyst was performed with exfoliation of the cyst, hemostasis on the wound surface of the bed of the cyst was performed with a bipolar electrocoagulator. Bipolar coagulation and resection of the ovarian tissue with no potential was used during surgical treatment of the ovaries, which made it possible to preserve the intact portion of the ovary as much as possible.
Results: Analysis of ovarian reserve indices, namely number of antral foliculs, number of antral follicles, AMG, and inhibin B levels in all examined patients with ovarian endometriomas were significantly lower than those of the control group before the start of treatment: in the ovarian endometrial group group 1.26 times (p <0.01), inhibin B - 1.5 times (p <0.01), the number of antral follicles - 1.2 times (p <0.01), due to the development dystrophic changes of the follicular apparatus due to prolonged compression, hypoxia, fibrosis in the ovaries. Patients who planned pregnancy were advised to have an active sexual life before menstruation was restored. In 23 (46.9%) of 49 patients who had reproductive plans, pregnancy occurred without first menstruation after a course of gonadotropin-releasing hormone agonists, 12 (24.5%) women became pregnant during the first three menstrual cycles. Extracorporeal fertilization was recommended for women who did not have pregnancy within 6 months of surgery. For two years in women who did not plan pregnancy, recurrence of endometriosis was not observed.
Conclusions: The combination of laparoscopic treatment with gonadotropin-releasing hormone agonists in patients with endometriosis with infertility allowed to restore reproductive function in 71.4% of women, which indicates the effectiveness of the treatment method used. In addition, it helps to achieve lasting remission and addresses the socio-social problems of women's health and maternity.
本研究的目的是通过联合治疗方法改善子宫内膜异位症患者的治疗效果。
材料与方法：对136名接受卵巢子宫内膜异位症腹腔镜手术的育龄妇女进行了为期两年的监测：第一组（n = 24）在围手术期未接受任何激素治疗；第二组（n = 32）在术后3个月内接受促性腺激素释放激素激动剂治疗；第三组（n = 80）在腹腔镜切除卵巢囊肿前使用促性腺激素释放激素激动剂——曲普瑞林3.75mg肌肉注射，持续2个月，并在术后3个月继续使用。对照组由30名月经周期规律的育龄健康妇女组成。所有患者均接受经阴道超声检查，记录治疗前后窦卵泡数量。在月经周期第2 - 3天以及治疗结束后第一个月经周期的第2 - 3天，通过Cobas e - 411分析仪（瑞士罗氏诊断公司）采用酶联免疫吸附测定法测定血清激素水平（促卵泡生成素、催乳素、促甲状腺激素、抗苗勒管激素、抑制素B）。腹腔镜下囊肿切除采用囊肿剥除术，囊肿床创面用双极电凝器止血。在卵巢手术治疗过程中，采用双极电凝和切除无功能的卵巢组织，尽可能保留卵巢的完整部分。
结果：在所有接受检查的卵巢子宫内膜异位症患者中，卵巢储备指标分析，即窦卵泡数量、抗苗勒管激素和抑制素B水平在治疗开始前均显著低于对照组：在卵巢子宫内膜组中，窦卵泡数量低1.26倍（p <0.01），抑制素B低1.5倍（p <0.01），窦卵泡数量低1.2倍（p <0.01），这是由于卵巢中卵泡装置因长期受压、缺氧、纤维化而发生营养不良性改变。计划怀孕的患者被建议在月经恢复前积极进行性生活。在49名有生育计划的患者中，23名（46.9%）在促性腺激素释放激素激动剂疗程后未恢复首次月经就怀孕了，12名（24.5%）妇女在头三个月经周期内怀孕。对于术后6个月内未怀孕的妇女，建议进行体外受精。在未计划怀孕的妇女中，两年内未观察到子宫内膜异位症复发。
结论：对于患有不孕症的子宫内膜异位症患者，腹腔镜治疗与促性腺激素释放激素激动剂联合使用可使71.4%的妇女恢复生殖功能，这表明所采用的治疗方法是有效的。此外，它有助于实现持久缓解，并解决了妇女健康和生育方面的社会问题。
