Geng L, Gu F Y, Zhang L Z
Third Hospital, Beijing Medical University.
Zhonghua Fu Chan Ke Za Zhi. 1994 Oct;29(10):592-4, 636.
Sixty patients with endometriosis, stage I-IV, diagnosed by laparoscopy or laparotomy, were treated with 200 micrograms of domestic luteinizing hormone-releasing hormone analogue (LHRH-A) subcutaneously twice daily, starting from the early follicular phase for 6-10 months. Serum FSH and LH levels elevated at first declined significantly thereafter, and remained low after the sixth day of treatment. Serum E2 concentrations were suppressed below that of the early follicular phase or to the castrated levels after one month of therapy. Symptoms and signs of endometriosis improved markedly during the treatment and patients became anovulatory and amenorrheic. At the end of treatment, resolution of endometriotic implants and softening of adhesions were shown under the second laparoscopy. Endometrial biopsies revealed inactive endometrium. After discontinuation of the treatment, ovulatory menses returned within 34-72 days, more than half of the patients complicated with infertility for 2-10 years became pregnant within 1-8 months. The recurrence rate was 37% after 0.5-5 year follow-up. Side effects were only related to hypooestrogenism. These data indicated that LHRH-A therapy had the effect of temporary reversible medical oophorectomy, and was therefore an effective approach for the treatment of endometriosis.
60例经腹腔镜或剖腹手术诊断为I - IV期子宫内膜异位症的患者,从卵泡早期开始,每日两次皮下注射200微克国产促黄体生成素释放激素类似物(LHRH - A),持续6 - 10个月。血清促卵泡生成素(FSH)和促黄体生成素(LH)水平起初升高,此后显著下降,治疗第6天后维持在低水平。治疗1个月后,血清雌二醇(E2)浓度被抑制至低于卵泡早期水平或达到去势水平。子宫内膜异位症的症状和体征在治疗期间明显改善,患者出现无排卵和闭经。治疗结束时,第二次腹腔镜检查显示子宫内膜异位病灶消退,粘连软化。子宫内膜活检显示子宫内膜呈静止状态。停药后,34 - 72天内恢复排卵性月经,半数以上患有2 - 10年不孕症的患者在1 - 8个月内怀孕。0.5 - 5年随访后的复发率为37%。副作用仅与雌激素缺乏有关。这些数据表明,LHRH - A治疗具有暂时可逆性药物性卵巢切除的作用,因此是治疗子宫内膜异位症的有效方法。