Seo Yong-Soo, Yuk Jin-Sung, Cho Yong-Kyoon, Shin Ji-Yeon
Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Korea.
Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.
J Pers Med. 2021 Sep 17;11(9):924. doi: 10.3390/jpm11090924.
This retrospective cohort study aimed to determine whether there is a difference in reoperation rates between patients who used dienogest (DNG) and patients who did not use DNG.
Using Health Insurance Review and Assessment Service (HIRA) data generated between 1 January 2010 and 30 June 2018, we identified women with an endometriosis diagnosis code who used GnRH agonists after gynecological surgery. Among them, women prescribed DNG were selected as the DNG group, and those who did not receive DNG were selected as the control group. A survival analysis of the reoperation between the two groups was performed.
DNG and control groups were extracted from 9735 people each. The reoperation rates were 0.4% and 0.6% in the DNG and control groups, respectively, without adjusting. In the Cox proportional risk analysis, DNG use increased the reoperation rate {hazard ratio (HR), 1.599; 95% confidence interval (CI), 1.005-2.545}. The site of endometriosis and the number of GnRH agonist injections were not associated with reoperation (HR, 1.008; 95% CI, 0.739-1.374; HR, 1.062; 95% CI, 0.690-1.635). In the subgroup survival analysis, according to the period between the last GnRH agonist injection and the first DNG dose, DNG did not increase the reoperation rates up to 9 months (3 months: HR, 0.968; 95% CI, 0.551-1.699; 46 months: HR, 1.094; 95% CI, 0.58-2.063; 79 months: HR, 2.419; 95% CI, 0.735-7.962), but DNG increased the reoperation rate from 10 months onwards (1012 months: HR, 3.826; 95% CI, 1.164-12.579 and ~13 months: HR, 8.436; 95% CI, 4.722-15.072).
Women who used DNG had a higher endometriosis reoperation rate than women who did not use DNG. However, the initiation of DNG treatment within nine months after the last GnRH agonist injection did not affect the endometriosis reoperation rate.
这项回顾性队列研究旨在确定使用地诺孕素（DNG）的患者与未使用DNG的患者在再次手术率上是否存在差异。
利用2010年1月1日至2018年6月30日期间健康保险审查与评估服务机构（HIRA）生成的数据，我们确定了患有子宫内膜异位症诊断代码且在妇科手术后使用促性腺激素释放激素（GnRH）激动剂的女性。其中，开具DNG处方的女性被选为DNG组，未接受DNG的女性被选为对照组。对两组之间的再次手术进行了生存分析。
DNG组和对照组各从9735人中提取。未调整时，DNG组和对照组的再次手术率分别为0.4%和0.6%。在Cox比例风险分析中，使用DNG会增加再次手术率{风险比（HR），1.599；95%置信区间（CI），1.005 - 2.545}。子宫内膜异位症的部位和GnRH激动剂注射次数与再次手术无关（HR，1.008；95% CI，0.739 - 1.374；HR，1.062；95% CI，0.690 - 1.635）。在亚组生存分析中，根据最后一次GnRH激动剂注射与首次DNG剂量之间的时间间隔，在9个月内（约3个月：HR，0.968；95% CI，0.551 - 1.699；4至6个月：HR，1.094；95% CI，0.58 - 2.063；7至9个月：HR，2.419；95% CI，0.735 - 7.962）使用DNG不会增加再次手术率，但从10个月起使用DNG会增加再次手术率（10至12个月：HR，3.826；95% CI，1.164 - 12.579；约13个月：HR, 8.436；95% CI，4.722 - 15.072）。
使用DNG的女性子宫内膜异位症再次手术率高于未使用DNG的女性。然而，在最后一次GnRH激动剂注射后9个月内开始DNG治疗不会影响子宫内膜异位症再次手术率。
