腹腔镜手术联合亮丙瑞林治疗子宫内膜异位症伴不孕的疗效及复发影响因素分析
Efficacy of Laparoscopic Surgery Combined With Leuprorelin in the Treatment of Endometriosis Associated With Infertility and Analysis of Influencing Factors for Recurrence.
作者信息
Yu Lu, Sun Yunming, Fang Qiongyan
机构信息
Department of Pharmacy, Zhoushan Women and Children Hospital, Zhoushan, China.
Department of Gynaecology, Zhoushan Women and Children Hospital, Zhoushan, China.
出版信息
Front Surg. 2022 Apr 19;9:873698. doi: 10.3389/fsurg.2022.873698. eCollection 2022.
OBJECTIVE
To explore the curative effect of laparoscopic surgery combined with leuprorelin in the treatment of endometriosis with infertility and the related factors of recurrence after treatment.
METHODS
A total of 158 patients with endometriosis and infertility were selected in our hospital from January 2019 to June 2020. Patients were randomly divided into the control group and the observation group, with 79 patients in each group. Patients in the control group was treated by laparoscopy surgery combined with dydrogesterone, while those in the observation group was treated with laparoscopic surgery combined with leuprorelin. The hormone levels, recurrence rate, pregnancy rate and adverse reaction of the two groups were compared. Combined with clinical and pathological information, the related factors of postoperative recurrence were analyzed.
RESULTS
After treatment, the levels of luteinizing hormone, follicle-stimulating hormone and estradiol in the observation group were lower than those in the control group ( < 0.05). The recurrence rate at 12 months after operation in the observation group was lower than that in the control group, and the pregnancy rate was higher than that in the control group ( < 0.05). However, there was no significant difference in the incidence of adverse reactions between the two groups ( > 0.05). Preoperative dysmenorrhea was an independent risk factor for postoperative recurrence in patients with endometriosis, and postoperative pregnancy was a protective factor for postoperative recurrence in patients with endometriosis ( < 0.05).
CONCLUSION
Laparoscopy combined with leuprorelin in the treatment of endometriosis with infertility can improve hormone levels, increase the pregnancy rate and reduce the recurrence rate. Preoperative dysmenorrhea is an independent risk factor for postoperative recurrence, which should be quantified and included in the recurrence risk prediction model. Postoperative pregnancy can reduce the recurrence rate after operation, and patients with fertility requirements should be encouraged to make activ preparations for postoperative pregnancy.
目的
探讨腹腔镜手术联合亮丙瑞林治疗子宫内膜异位症合并不孕症的疗效及治疗后复发的相关因素。
方法
选取2019年1月至2020年6月我院收治的158例子宫内膜异位症合并不孕症患者。将患者随机分为对照组和观察组，每组79例。对照组采用腹腔镜手术联合地屈孕酮治疗，观察组采用腹腔镜手术联合亮丙瑞林治疗。比较两组患者的激素水平、复发率、妊娠率及不良反应。结合临床及病理资料，分析术后复发的相关因素。
结果
治疗后，观察组促黄体生成素、促卵泡生成素及雌二醇水平低于对照组（P<0.05）。观察组术后12个月复发率低于对照组，妊娠率高于对照组（P<0.05）。然而，两组不良反应发生率比较差异无统计学意义（P>0.05）。术前痛经是子宫内膜异位症患者术后复发的独立危险因素，术后妊娠是子宫内膜异位症患者术后复发的保护因素（P<0.05）。
结论
腹腔镜联合亮丙瑞林治疗子宫内膜异位症合并不孕症可改善激素水平，提高妊娠率，降低复发率。术前痛经是术后复发的独立危险因素，应进行量化并纳入复发风险预测模型。术后妊娠可降低术后复发率，对有生育要求的患者应鼓励其积极做好术后妊娠准备。
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