Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.
J Int Med Res. 2020 Jun;48(6):300060520931666. doi: 10.1177/0300060520931666.
To compare the efficacy of postoperative adjuvant treatment (gonadotropin-releasing hormone agonists [GnRHas] and oral contraceptives [OCs]) and expectant treatment in preventing recurrent dysmenorrhea following conservative laparoscopic surgery for deep infiltrating endometriosis (DIE) with dysmenorrhea.
A prospective cohort study was conducted in Shanghai, China. In total, 147 patients with dysmenorrhea who underwent conservative laparoscopic surgery for DIE were enrolled. Following surgery, patients received either postoperative adjuvant therapy (GnRHa or OCs) for 6 months or expectant treatment according to a shared medical decision-making approach. The primary outcome was the postoperative recurrence of dysmenorrhea. The secondary outcomes included reproductive outcomes and drug-induced side effects.
The generalized estimating equation analysis illustrated that the visual analog scale for dysmenorrhea was significantly higher in the adjuvant treatment group than in the expectant treatment group. Kaplan-Meier analysis and the log-rank test demonstrated that the cumulative recurrence rate was higher in the expectant treatment group than in the adjuvant treatment group, but no difference was noted between the two hormonal treatments. Similar cumulative 24-month clinical pregnancy rates were observed among the three groups.
Compared with expectant management, postoperative medical treatment more effectively relieved symptoms and prevented the recurrence of dysmenorrhea.
比较术后辅助治疗（促性腺激素释放激素激动剂[GnRHa]和口服避孕药[OC]）与期待治疗对预防有痛经症状的深部浸润型子宫内膜异位症（DIE）行保守性腹腔镜手术后痛经复发的疗效。
在中国上海进行了一项前瞻性队列研究。共纳入 147 例有痛经症状且行 DIE 保守性腹腔镜手术的患者。术后，患者接受术后辅助治疗（GnRHa 或 OC）6 个月或根据共同决策方法接受期待治疗。主要结局为术后痛经复发。次要结局包括生殖结局和药物引起的副作用。
广义估计方程分析表明，辅助治疗组的痛经视觉模拟量表评分明显高于期待治疗组。Kaplan-Meier 分析和对数秩检验表明，期待治疗组的累积复发率高于辅助治疗组，但两种激素治疗之间无差异。三组的累积 24 个月临床妊娠率相似。
与期待管理相比，术后药物治疗更有效地缓解症状并预防痛经复发。
