腹腔鏡手術(shù)聯(lián)合GnRH—a治療子宮內(nèi)膜異位癥伴不孕患者的療效分析

　　【摘要】 目的：探討子宮內(nèi)膜異位癥伴不孕患者采用腹腔鏡手術(shù)聯(lián)合GnRH-a治療的臨床療效。方法：回顧性分析2012年12月-2016年12月本院收治的子宮內(nèi)膜異位癥伴不孕患者75例的臨床資料，根據(jù)患者就診號(hào)將其分為觀察組（單號(hào)）38例和對(duì)照組（雙號(hào)）37例。對(duì)照組患者采用腹腔鏡手術(shù)治療，觀察組患者采用腹腔鏡手術(shù)聯(lián)合GnRH-a治療。比較兩組患者的治療效果、妊娠率、復(fù)發(fā)率及不良反應(yīng)發(fā)生情況。結(jié)果：觀察組患者顯效率、總有效率、妊娠率分別為52.63%、97.37%、34.21%，均高于對(duì)照組的29.73%、81.08%、13.51%，比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；觀察組患者復(fù)發(fā)率為15.79%，低于對(duì)照組的37.84%，比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；觀察組患者不良反應(yīng)發(fā)生率為7.89%，高于對(duì)照組的5.41%，但比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：腹腔鏡手術(shù)聯(lián)合GnRH-a治療可有效提高子宮內(nèi)膜異位癥的臨床效果及患者妊娠率。
　　【關(guān)鍵詞】 腹腔鏡； GnRH-a； 子宮內(nèi)膜異位癥伴不孕； 療效
　　Efficacy of Laparoscopy Surgery Combined with GnRH-a in Treatment of Endometriosis with Infertility/LI Shi，JIN Sufang，MA Wenjun.//Medical Innovation of China，2018，15（07）：021-024
　　【Abstract】 Objective：To investigate the clinical effect of laparoscopy combined with GnRH-a in treatment of endometriosis with infertility.Method：The clinical data of 75 cases of endometriosis with infertility treated in our hospital from December 2012 to December 2016 were retrospectively analyzed.According to the number of patients，they were divided into 38 cases of observation group（single number） and 37 cases of control group（double number）.The control group was treated with laparoscopic surgery，and observation group was treated with laparoscopic surgery combined with GnRH-a.The treatment effect，pregnancy rate，recurrence rate and the occurrence of adverse reactions between two groups were compared.Result：The effective rate，total effective rate and pregnancy rate of observation group were 52.63%，97.37% and 34.21% respectively，which were higher than 29.73%，81.08%，13.51% in control group，the differences were statistically significant（P<0.05）.The recurrence rate of observation group was 15.79%，which was lower than 37.84% of control group，the difference was statistically significant（P<0.05）.The incidence of adverse reactions in observation group was 7.89%，which was higher than 5.41% of control group，but the difference was not statistically significant（P>0.05）.Conclusion：Laparoscopic surgery combined with GnRH-a can effectively improve the clinical effect and pregnancy rate of patients with endometriosis.
　　【Key words】 Laparoscopy； GnRH-a； Endometriosis with infertility； Curative effect
　　First-author’s address：Shenzhen Hospital of Guangzhou University of Chinese Medicine，Shenzhen 518034，China
　　doi：10.3969/j.issn.1674-4985.2018.07.006
　　子宮內(nèi)膜異位癥是婦科臨床常見疾病，可造成患者不孕或慢性盆腔疼痛，好發(fā)于育齡期女性，是女性生育年齡階段常見疾病[1-2]，患病率10%～15%，近年來該疾病發(fā)病率呈增高趨勢(shì)，30～40歲女性患子宮內(nèi)膜異位癥者約25%，其中50%子宮內(nèi)膜異位癥患者可出現(xiàn)不孕癥[3]，成為導(dǎo)致育齡女性不孕的三大因素之一（輸卵管、排卵障礙及子宮內(nèi)膜異位癥）。研究發(fā)現(xiàn)，子宮內(nèi)膜異位癥可導(dǎo)致女性生育能力下降還可增加自然流產(chǎn)、宮外孕、早產(chǎn)等不良妊娠結(jié)局的發(fā)生率[4]，對(duì)患者的生活質(zhì)量、家庭和社會(huì)穩(wěn)定產(chǎn)生嚴(yán)重影響。目前臨床治療子宮內(nèi)膜異位癥常采用藥物治療和手術(shù)治療兩種[5]，藥物治療可緩解患者癥狀、治療后妊娠率不高且復(fù)發(fā)率較高。隨著腹腔鏡手術(shù)廣泛應(yīng)用于婦科[6]，其可減滅病變、分離粘連、減輕患者癥狀及促進(jìn)生育，成為治療子宮內(nèi)膜異位癥的首選手術(shù)方式[7-8]。文獻(xiàn)[9]報(bào)道顯示，腹腔鏡手術(shù)與藥物聯(lián)合治療子宮內(nèi)膜異位癥伴不孕癥患者后可提高患者妊娠率及降低其復(fù)發(fā)率。本次筆者采用腹腔鏡聯(lián)合GnRH-a（諾雷德）治療子宮內(nèi)膜異位癥伴不孕患者進(jìn)行效果研究，現(xiàn)報(bào)道如下。

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