保守性手术联合米非司酮治疗中重度子宫内膜异位症

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1、保守性手术联合米非司酮治疗中重度子宫内膜异位症【关键词】米非司酮；促性腺激素释放激素；子宫内膜异位症　　［摘要］目的：探讨米非司酮(Ru486)用于中重度子宫内膜异位症患者保守性手术后巩固治疗的临床效果及安全性。方法：将资料完整的中重度子宫内膜异位症行保守性手术治疗的患者90例，分为米非司酮组、促性腺激素释放激素激动剂(GnRHa)组及对照组。米非司酮组30例，术后第1次月经来潮第5天始口服米非司酮12．5mg／d，共6个月；GnRHa组30例，术后月经来潮第5天，皮下注射亮丙瑞林3．75mg，30d注射1次，共6次；对照组30例，术后未用药物治疗。观察治疗前

2、后患者疼痛症状和体征的临床缓解情况、性激素水平变化及副反应。结果：米非司酮组及GnRHa组患者疼痛症状和体征完全缓解率分别为90％及93．3％，显著高于对照组的53．3％，差异有统计学意义(P<0．01)，米非司酮组及GnRHa组患者累积复发率均为6．7％，显著低于对照组的30％(P<0．05)，而米非司酮组与GnRHa组比较，差异无统计学意义(P>0．05)。米非司酮组用药前雌二醇水平为(206±15)pmol／L，用药后雌二醇水平显著下降至(120±9)pmol／L，但仍维持在卵泡早期水平。GnRHa组用药前雌二醇水平为(214±16)p

3、mol/L，用药后雌二醇水平显著下降至(62±9)pmol／L，达绝经期水平。结论：米非司酮用于子宫内膜异位症术后的巩固治疗，有效、方便、价廉、副作用少。11　　［关键词］米非司酮；促性腺激素释放激素；子宫内膜异位症　　ConservativeSurgeryCombinedWithMifepristoneInTreatmentOfModerateOrSevereEndometriosis　　Abstract:ObjectiveToevaluatetheefficiencyandsafetyofmifepristone(Ru486)intreatmentofmo

4、derateorsevereendometriosisafterconservativesurgery.MethodsNinetywomenwithmoderateorsevereendometriosisafterconservativesurgeryweredividedintothreegroups:mifepristonegroup(30cases,mifepristone12.5mg/d,6months);gonadotropinreleasinghormoneagonist(GnRHa)group(30cases,hypodermicallyleu

5、prorelinacetate,3.75mg/ml,6months);controlgroup(30cases)didnotreceiveanypostoperativemedicaltreatment.Patients'symptomsandsignsincludingpelvicpain,andpelvictendernesswererecordedbeforeandaftertreatment.Sideeffectswererecordedaftertreatment.Sexhormonelevelswerealsoexaminedatthesameti

6、me.ResultsBothRu486andGnRHatreamentachievedsimilarsignificantreliefofpelvicsymptomsandsigns(90%and93.3%)comparedwiththecontrol11group(P<0.01).BoththecumulativerecurrenceratesofRu486andGnRHagroupswere6.7%,significantlowerthanthatofthecontrolgroup(P<0.05).Therewerenosignificantd

7、ifferencesbetweenRu486andGnRHagroups(P<0.05).Serumestradiol(E2)levelwassignificantlyreducedinbothRu486andGnRHagroups,butwasmaintainedatthelevelofearlyfollicularphaseinthegroupofRu486(120±9)pmol/LandmenopausephaselevelinthegroupofGnRHa(62±9)pmol/L.ConclusionRu486seemstobeaneffecti

8、ve,safe,andconvenie