腹腔镜手术联合GnRH—a治疗子宫内膜异位症伴不孕患者的疗效分析

　　【摘要】 目的：探讨子宫内膜异位症伴不孕患者采用腹腔镜手术联合GnRH-a治疗的临床疗效。方法：回顾性分析2012年12月-2016年12月本院收治的子宫内膜异位症伴不孕患者75例的临床资料，根据患者就诊号将其分为观察组（单号）38例和对照组（双号）37例。对照组患者采用腹腔镜手术治疗，观察组患者采用腹腔镜手术联合GnRH-a治疗。比较两组患者的治疗效果、妊娠率、复发率及不良反应发生情况。结果：观察组患者显效率、总有效率、妊娠率分别为52.63%、97.37%、34.21%，均高于对照组的29.73%、81.08%、13.51%，比较差异均有统计学意义（P<0.05）；观察组患者复发率为15.79%，低于对照组的37.84%，比较差异有统计学意义（P<0.05）；观察组患者不良反应发生率为7.89%，高于对照组的5.41%，但比较差异无统计学意义（P>0.05）。结论：腹腔镜手术联合GnRH-a治疗可有效提高子宫内膜异位症的临床效果及患者妊娠率。
　　【关键词】 腹腔镜； GnRH-a； 子宫内膜异位症伴不孕； 疗效
　　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
　　子宫内膜异位症是妇科临床常见疾病，可造成患者不孕或慢性盆腔疼痛，好发于育龄期女性，是女性生育年龄阶段常见疾病[1-2]，患病率10%～15%，近年来该疾病发病率呈增高趋势，30～40岁女性患子宫内膜异位症者约25%，其中50%子宫内膜异位症患者可出现不孕症[3]，成为导致育龄女性不孕的三大因素之一（输卵管、排卵障碍及子宫内膜异位症）。研究发现，子宫内膜异位症可导致女性生育能力下降還可增加自然流产、宫外孕、早产等不良妊娠结局的发生率[4]，对患者的生活质量、家庭和社会稳定产生严重影响。目前临床治疗子宫内膜异位症常采用药物治疗和手术治疗两种[5]，药物治疗可缓解患者症状、治疗后妊娠率不高且复发率较高。随着腹腔镜手术广泛应用于妇科[6]，其可减灭病变、分离粘连、减轻患者症状及促进生育，成为治疗子宫内膜异位症的首选手术方式[7-8]。文献[9]报道显示，腹腔镜手术与药物联合治疗子宫内膜异位症伴不孕症患者后可提高患者妊娠率及降低其复发率。本次笔者采用腹腔镜联合GnRH-a（诺雷德）治疗子宫内膜异位症伴不孕患者进行效果研究，现报道如下。