ObjectiveTo explore the clinical effect and safety of laparoscopic cytoreductive surgery combined with gestrinone in the treatment of adenomyosis. MethodsWe retrospectively analyzed the clinical data of 82 patients with adenomyosis who accepted treatment in our hospital from January 2008 to April 2011. According to different treatment method, the patients were divided into three groups. Twenty-seven patients in the treatment group underwent laparoscopic cytoreductive surgery combined with postoperative treatment with gestrinone. For the 25 patients in the surgery group, only laparoscopic cytoreductive surgery was performed, and 30 other patients who only received oral gestrinone were designated as the medicine group. Dysmenorrhea, menstrual volume, uterine size, serum carcinoembryonic antigen 125 (CA125), anemia, and drug side effects were respectively recorded before and after surgery. ResultsThe dysmenorrhea degree reduced significantly in all the three groups. There was no significant difference in the degree of dysmenorrhea, menstrual volume, and uterine volume between the treatment group and the surgery group (P>0.05); the dysmenorrhea degree was significantly different between the treatment group and the medicine group (P<0.05); the differences in hemoglobin levels and the serum CA125 level between the treatment group and the surgery group 12 months later were significant (P=0.019, P=0.049). ConclusionThe laparoscopic cytoreductive surgery combined with gestrinone in treating adenomyosis can improve recent curative effect and provide more effective symptom control compared with surgery alone.
【摘要】 目的 觀察腹腔鏡手術聯合孕三烯酮治療子宮內膜異位癥合并不孕的療效及不同評分系統對妊娠結局的預測價值。 方法 回顧性分析2004年1月-2006年12月收治的97例子宮內膜異位癥合并不孕患者的臨床病理資料，統計其術后妊娠率及活產率。 結果 術后1年內與1~2年的妊娠率與活產率比較，差異均無統計學意義（Pgt;0.05）。根據美國生育協會1985年修訂的子宮內膜異位癥分期標準（r-AFS）進行分期，各期患者術后妊娠率差異無統計學意義（Pgt;0.05）；但隨著分期升高，活產率逐漸下降（Plt;0.05）。子宮內膜異位癥生育指數（EFI）評分越高，其妊娠率和活產率也越高（Plt;0.05）。 結論 子宮內膜異位癥患者腹腔鏡手術后聯用孕三烯酮可能會提高遠期妊娠率。r-AFS分期對妊娠結局的預測有一定局限性，而EFI具有較好的預測性。【Abstract】 Objective To evaluate the therapeutic effectiveness of laparoscopic surgery combined with gestrinone treatment in the infertile women with endometriosis (EM), and the value of different score systems to predict gestational outcome. Methods We retrospectively analyzed the clinical data of 97 infertile women with EM who were treated in our hospital from January 2004 to December 2006, and collected their pregnancy rate (PR) and live birth rate (LBR) after operation. Results There was no significant difference of PR and LBR within the 1st year and between the 1st and the 2nd year (Pgt;0.05). There was no significant difference of PR among women of various stages of EM based on the 1985 edition of risk stratification for patients with EM put forward by American Fertility Society (r-AFS) (Pgt;0.05), but the LBR decreased with the raising of the stages (Plt;0.05). The endometriosis fertility index (EFI) was positively correlated with PR and LBR (Plt;0.05). Conclusion Laparoscopic surgery combined with gestrinone may increase the long-term pregnancy rate of women with EM. R-AFS classification is limited in predicting the gestational outcome of women with EM, while EFI achieves a better result.