Clinical value of laparoscopic conservative operations combined with gonadotropin-releasing hormone analogue on treatment of moderate and severe ovarian endometriosis / 中国医师进修杂志

ABSTRACT

Objective To explore the clinical value of gonadotropin-releasing hormone analogue (GnRH-a) by analyzing the efficiency of GnRH-a treatment for moderate and severe endometriosis after laparoscopic conservative operations.Methods Two hundred and sixty-five females who accepted laparoscopic conservative operation were enrolled in this study,and they were confirmed by pathology for ovarian endometriosis cyst,in phase Ⅲ andⅣ,47 patients had fertility desire.According to whether use the drug and auxiliary species the postoperative cases were divided into 5 groups102 cases without endocrinal therapy(untreated group),GnRH-a group of 3 months in 64 cases,GnRH-a group of 6 months in 31 cases;gestrinone group of 3 months in 38 cases,and gestrinone group of 6 months in 30 cases.All patients were followed up for 2 years,observed drug clinical effects,remission rate,improvement rate,recurrence rate,pregnancy outcomes and side effects.Results The remission rate in GnRH-a group of 6 months and gestrinone group of 6 months was significantly higher than that in untreated group [83.9％ (26/31),73.3％ (22/30) vs.52.9％(54/102)],the remission rate in GnRH-a group of 6 months was significantly higher than that GnRH-a group of 3 months [64.1％ (41/64)],there was significant difference (P ＜ 0.05).The recurrence rate in GnRH-a group of 3 months,GnRH-a group of 6 months,gestrinone group of 6 months was significantly lower than that in untreated group [12.5％ (8/64),9.7％ (3/31),10.0％ (3/30) vs.27.5％ (28/102)] (P ＜ 0.05).The recurrence rate in gestrinone group of 6 months was significantly lower than that in gestrinone group of 3 months (P ＜ 0.05).The recurrence time of GnRH-a group of 3 months,GnRH-a group of 6 months,gestrinone group of 6 months was significantly longer than that in untreated group [(14.05 ± 1.97),(16.76 ± 1.53),(16.12 ±2.15)months vs.(12.85 ± 1.80)months] (P ＜0.05).The recurrence time of gestrinone group of 3 months and untreated group had no significant difference(P ＞ 0.05).The pregnancy rate of GnRH-a group and gestrinone group was higher than that in untreated group,but there was no significant difference (P ＞ 0.05).The rate of menopausal symptom in GnRH-a group was higher than that in gestrinone group [50.5％ (48/95) vs.16.2％ (11/68)].The rate of abnormal bleeding in vagina,acne and side-effect of aminotransferase in GnRH-a group were significantly lower than those in gestrinone group [1.1％(1/95) vs.7.4％(5/68),0 vs.8.8％(6/68),0 vs.5.9％(4/68)](P＜ 0.05).Conclusions Laparoscopic conservative operations combined with GnRH-a on treatment of moderate and severe ovarian endometriosis can significantly improve remission rate,decrease recurrence rate.GnRH-a or gestrinone for 6 months,the pregnancy rate increases.In addition the side reactions of the two medicine have statistic difference,which of GnRH-a is lower.