摘要
目的探讨地诺孕素联合腹腔镜手术治疗育龄期卵巢型子宫内膜异位症(endometriosis,EMT)的临床效果。方法选取2021年1月—2023年6月新乡医学院第一附属医院收治的卵巢型EMT患者82例为研究对象,按随机数字表法分为对照组与观察组,各41例。2组均行腹腔镜手术治疗,对照组术后予以醋酸亮丙瑞林治疗,观察组术后予以地诺孕素治疗。比较2组治疗后的血清炎症指标、卵巢功能指标、血管生长因子活性指标水平及生活质量、妊娠情况、不良反应发生情况。结果治疗3个月后,观察组的C反应蛋白(C-reactive protein,CRP)、前列腺素E_(2)(prostaglandin E_(2),PGE_(2))、前列腺素F2α(prostaglandin F_(2α),PGF_(2α))、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平分别为(9.04±1.12)mg/L、(285.63±25.39)pg/mL、(150.41±15.41)pg/m L、(8.96±1.15)pg/m L、(1.67±0.23)pg/m L,低于对照组的(10.87±1.18)mg/L、(324.28±30.31)pg/m L、(174.35±16.38)pg/m L(、10.67±1.26)pg/m L(、2.21±0.35)pg/m L,差异均有统计学意义(P<0.05)。观察组的抗米勒管激素(anti-Müllerian hormone,AMH)水平为(5.07±1.05)ng/mL,高于对照组的(4.53±0.67)ng/mL,双侧卵巢窦状卵泡数(antral follicle count,AFC)为(7.05±1.12)个,多于对照组的(6.11±0.88)个,卵泡刺激素(follicle-stimulating hormone,FSH)水平为(5.04±0.89)U/L,低于对照组的(6.11±1.12)U/L,差异均有统计学意义(P<0.05)。观察组的血管内皮生长因子(vascular endothelial growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,b FGF)、血小板衍生生长因子(platelet-derived growth factor,PDGF)水平分别为(14.15±1.24)ng/mL、(52.36±5.11)ng/L、(16.25±1.27)μg/mL,低于对照组的(15.89±1.27)ng/mL、(56.69±5.42)ng/L、(18.96±1.42)μg/mL,差异均有统计学意义(P<0.05)。观察组世界卫生组织生活简易量表(the World Health Organization quality of life-brief form questionnaire,WHOQOL-BREF)的心理、生理、社会、环境4个领域评分分别为(87.96±4.88)分、(85.74±5.25)分、(88.67±4.52)分、(89.48±4.56)分,高于对照组的(81.41±5.15)分、(80.36±5.19)分、(83.18±4.43)分、(84.29±5.12)分,差异均有统计学意义(P<0.05)。观察组不良反应发生率为4.88%,低于对照组的21.95%,差异有统计学意义(P<0.05)。随访半年,观察组的妊娠率为60.98%,高于对照组的36.59%,差异有统计学意义(P<0.05)。结论地诺孕期联合腹腔镜手术治疗卵巢型EMT效果更佳,可加快炎症消退,促进卵巢功能恢复,提高妊娠率,更好改善患者生活质量,且安全性高。
Objective To investigate the clinical efficacy of the combination of dienogest and laparoscopic surgery in the treatment of ovarian endometriosis(EMT)of childbearing age.Methods A total of 82 patients with ovarian EMT admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2021 to June 2023 were selected as the study subjects.They were divided into a control group and an observation group according to the random number table method,with 41 patients in each group.Both groups underwent laparoscopic surgery.The control group received postoperative treatment with leuprorelin acetate,while the observation group received postoperative treatment with dienogest.The indicator levels of serum inflammatory,ovarian function,vascular growth factor activity,and quality of life,pregnancy status,incidence of adverse reactions were compared between two groups after treatment.Results After 3 months of treatment,the levels of C-reactive protein(CRP),prostaglandin E_(2)(PGE_(2)),prostaglandin F_(2α)(PGF_(2α)),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the observation group were(9.04±1.12)mg/L,(285.63±25.39)pg/mL,(150.41±15.41)pg/mL,(8.96±1.15)pg/mL,and(1.67±0.23)pg/mL,respectively,which were lower than those in the control group(10.87±1.18)pg/mLmg/L,(324.28±30.31)pg/mL,(174.35±16.38)pg/mL,(10.67±1.26)pg/mL,(2.21±0.35)pg/mL,and the differences were statistically significant(P<0.05).The level of anti-Müllerian hormone(AMH)in the observation group was(5.07±1.05)ng/mL,which was higher than the control group's(4.53±0.67)ng/mL;the number of antral follicle count(AFC)in both ovaries was(7.05±1.12),which was higher than the control group's(6.11±0.88);the level of follicle stimulating hormone(FSH)was(5.04±0.89)U/L,which was lower than the control group's(6.11±1.12)U/L.The differences were statistically significant(P<0.05).The levels of vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and platelet-derived growth factor(PDGF)in the observation group were(14.15±1.24)ng/mL,(52.36±5.11)ng/L,and(16.25±1.27)μg/mL,respectively,which were lower than those in the control group(15.89±1.27)ng/mL,(56.69±5.42)ng/L,and(18.96±1.42)μg/mL,and the differences were statistically significant(P<0.05).The psychological,physiological,social,and environmental scores of the World Health Organization quality of life-brief form questionnaire(WHOQOL-BREF)in the observation group were(87.96±4.88)points,(85.74±5.25)points,(88.67±4.52)points,and(89.48±4.56)points,respectively,which were higher than those of the control group(81.41±5.15)points,(80.36±5.19)points,(83.18±4.43)points,and(84.29±5.12)points,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 4.88%,which was lower than 21.95%in the control group,and the difference was statistically significant(P<0.05).After a six-month follow-up,the pregnancy rate of the observation group was 60.98%,which was higher than the 36.59%of the control group,and the difference was statistically significant(P<0.05).Conclusion The combination of dienogest and laparoscopic surgery is more effective in treating ovarian EMT,which can accelerate inflammation resolution,promote ovarian function recovery,increase pregnancy rate,better improve patients'quality of life,and has high safety.
作者
丁亚蕊
杨君
王慧玲
DING Yarui;YANG Jun;WANG Huiling(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang Henan 453000,China)
出处
《中国卫生标准管理》
2025年第14期141-145,共5页
China Health Standard Management
