Regidor P A, Schindler A E, Bühler K, Gerhard I, Kimmig R, Meinen K, Hoffmann G, Lübben G, Kienle E
Universitätsfrauenklinik Essen.
Zentralbl Gynakol. 1996;118(5):283-90.
In a previous study 198 patients with histologically confirmed endometriosis underwent a "three-step" therapy, where surgical removal of endometriosis implants was followed by a 6 months treatment with 3.75 mg leuprorelinacetate depot as monthly subcutaneous injections and a second look laparoscopy with removal of residuals. In the following report long-term follow-up data generated in 112 of the above 198 patients on the post-treatment effect in respect to symptoms and pregnancy outcome in infertility are reported. For this purpose a special questionnaire was used. The follow-up period was up to 60 months with a median time of 33.5 months. Out of 112 patients 91 complained of infertility. 43 out of these 91 (47.3 %) became pregnant during the follow-up period, resulting in 55 pregnancies and 36 newborns. More than half of these patients conceived spontaneously, whereas in the rest stimulation programs became necessary. Recurrence of dysmenorrhoea, dyspareunia and pelvic pain was defined as recurrence of disease. During the follow-up period 70/112 (62.5 %) of the patients complained recurrence of symptoms with median first onset at 11 months. In two third symptoms were still less severe than at admission and classified as mild and moderate. The r-AFS score at first and second look laparoscopy did not differ in patients with and without recurrence of disease (p = 0.311 and 0.750). Only 28.6 % (20/70) of patients required an additional medical or surgical treatment. A subgroup of 51 patients could be evaluated in respect to quality of life and improvement of subjective conditions. Regain of quality of life and improvement of subjective conditions were reported in 54.9 % (28/51) and 52.9 % (27/51) respectively. The study results suggest that although the physiological effects of leuprorelin acetate treatment as suppression of ovarian function is rapidly reversible, the therapeutic effects linger, as evidenced by ongoing reduction of symptoms from baseline, leaving many patients asymptomatic or much improved longer than 1 year after treatment has ended. Besides long term relief and/or sustained reduction in symptom severity, the high pregnancy rate in infertility, as well as regain of quality of life and well being favour this therapeutic approach in endometriosis.
在之前的一项研究中，198例经组织学确诊的子宫内膜异位症患者接受了“三步”疗法，即手术切除子宫内膜异位症植入物，随后每月皮下注射3.75mg醋酸亮丙瑞林缓释剂进行6个月的治疗，之后进行二次腹腔镜检查以清除残留病灶。在以下报告中，我们报告了上述198例患者中112例的长期随访数据，涉及治疗后症状和不孕症妊娠结局方面的情况。为此使用了一份特殊问卷。随访期长达60个月，中位时间为33.5个月。112例患者中有91例主诉不孕。这91例中的43例（47.3%）在随访期内怀孕，共妊娠55次，分娩36例新生儿。这些患者中一半以上自然受孕，其余患者则需要进行促排卵治疗。痛经、性交困难和盆腔疼痛的复发被定义为疾病复发。在随访期内，70/112（62.5%）的患者主诉症状复发，首次发作的中位时间为11个月。三分之二的患者症状仍比入院时轻，分类为轻度和中度。有疾病复发和无疾病复发的患者在首次和二次腹腔镜检查时的r-AFS评分无差异（p = 0.311和0.750）。只有28.6%（20/70）的患者需要额外的药物或手术治疗。可以对51例患者的生活质量和主观状况改善情况进行评估。分别有54.9%（28/51）和52.9%（27/51）的患者报告生活质量恢复和主观状况改善。研究结果表明，尽管醋酸亮丙瑞林治疗抑制卵巢功能的生理效应可迅速逆转，但治疗效果仍持续存在，从基线开始症状持续减轻即可证明，许多患者在治疗结束后1年以上无症状或症状明显改善。除了长期缓解和/或症状严重程度持续降低外，不孕症患者的高妊娠率以及生活质量和幸福感的恢复都有利于这种子宫内膜异位症的治疗方法。
