GnRH-a联合左炔诺孕酮宫内缓释系统在子宫内膜异位症腹腔镜保守性手术后的应用OA
Application of GnRH-a Combined with Levonorgestrel-releasing Intrauterine System after Laparoscopic Conservative Surgery for Endometriosis
目的:探讨子宫内膜异位症患者在腹腔镜保守性手术后应用促性腺激素释放激素激动剂(GnRH-a)及左炔诺孕酮宫内缓释系统的效果,并分析联合疗法对患者卵巢功能、氧化应激指标及子宫内膜容受性的影响.方法:选取南京医科大学附属江苏盛泽医院 2021 年 8 月—2024 年 12 月收治的行腹腔镜保守性手术的子宫内膜异位症患者 110 例作为研究对象,以随机数字表法分为对照组和试验组,各55 例.对照组术后采用GnRH-a(醋酸亮丙瑞林)治疗,试验组术后采用GnRH-a联合左炔诺孕酮宫内缓释系统治疗.对比两组疗效及不良反应,观察两组卵巢功能[血清抗米勒管激素(AMH)、窦卵泡计数(AFC)]、氧化应激指标[活性氧(ROS)、对氧磷酶 1(PON1)]、子宫内膜容受性[螺旋动脉的搏动指数(PI)、阻力指数(RI)].结果:术后 6 个月,试验组总缓解率高于对照组(P<0.05).术后 6 个月,试验组AMH高于对照组,AFC多于对照组(P<0.05).术后 6 个月,试验组ROS低于对照组,PON1 高于对照组(P<0.05).术后 6 个月,试验组PI、RI水平低于对照组(P<0.05).试验组不良反应发生率与对照组比较,差异无统计学意义(P>0.05).结论:子宫内膜异位症患者在腹腔镜保守性手术后应用GnRH-a及左炔诺孕酮宫内缓释系统可减轻疼痛程度及氧化应激反应,提高子宫内膜容受性,促进卵巢功能恢复,且安全性高.
Objective:To investigate the effect of combined application of gonado-tropin-releasing hormone agonist(GnRH-a)and Levonorgestrel-releasing Intrauterine System in patients with endometriosis after laparoscopic conservative surgery,and to analyze the influence of the combined therapy on ovarian function,oxidative stress indicators and endometrial receptivity of the patients.Method:A total of 110 patients with endometriosis who underwent laparoscopic conservative surgery in Jiangsu Shengze Hospital Affiliated to Nanjing Medical University from August 2021 to December 2024 were selected as the research object.Using the random number table method,the patients were divided into the control group and the experimental group with 55 cases in each group.The control group was treated with GnRH-a(Leuprorelin Acetate)after surgery,and the experimental group was treated with GnRH-a combined with Levonorgestrel-releasing Intrauterine System after surgery.The therapeutic effects and adverse reactions of the two groups were compared,the ovarian function[serum anti-Müllerian hormone(AMH),antral follicle count(AFC)],oxidative stress indexes[reactive oxygen species(ROS),paraoxonase 1(PON1)],endometrial receptivity indexes[pulsatility index(PI)and resistance index(RI)of helicine artery]in the two groups were observed.Result:Six months after the surgery,the total remission rate of the experimental group was higher than that of the control group(P<0.05).Six months after the surgery,the AMH levels of the experimental group was higher than that of the control group,and the AFC was more than that of the control group(P<0.05).Six months after the surgery,the ROS of the experimental group was lower than that of the control group,and the PON1 was higher than that of the control group(P<0.05).Six months after the surgery,the PI and RI levels of the experimental group were lower than those of the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the experimental group and the control group(P>0.05).Conclusion:For patients with endometriosis,the application of GnRH-a and Levonorgestrel-releasing Intrauterine System after laparoscopic conservative surgery can alleviate pain levels and oxidative stress responses,improve endometrial receptivity,promote ovarian function recovery,and has high safety.
徐小丽;王雁
南京医科大学附属江苏盛泽医院妇产科 江苏 苏州 215228南京医科大学附属江苏盛泽医院妇产科 江苏 苏州 215228
医药卫生
子宫内膜异位症腹腔镜保守性手术促性腺激素释放激素激动剂左炔诺孕酮宫内缓释系统
EndometriosisLaparoscopic conservative surgeryGonado-tropin-releasing hormone agonistLevonorgestrel-releasing Intrauterine System
《中国医学创新》 2026 (19)
15-20,6
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