摘要
目的:探讨卵巢内膜样囊肿保守性手术后不同药物治疗方案对复发的预防作用,并选出最优药物治疗方案。方法:选取2015年7月至2017年2月复旦大学附属妇产科医院收治的行腹腔镜下保守性手术的卵巢内膜样囊肿患者136例,按照术后药物处理方案分为4组,即单纯手术组(n=58)、促性腺激素释放激素激动剂(GnRHa)治疗组(术后注射3个周期GnRHa,n=28)、避孕药治疗组(术后口服避孕药12个月,n=20)和序贯治疗组(术后先给予3个周期的GnRHa注射,月经恢复后口服避孕药至术后12个月,n=30)。于术后1、3、6、12、18、24个月随访,比较各组患者的累计复发率、不良反应,并分析术后复发的影响因素。结果:随访24个月,136例患者中23例复发,复发率为16.9%。单纯手术组、GnRHa治疗组、避孕药治疗组、序贯治疗组患者的累计复发率分别为28.3%、28.1%、15.0%、3.3%,中位无复发间期分别为27.37、25.89、29.47、30.16个月。序贯治疗组患者术后24个月的累计复发率明显低于单纯手术组、GnRHa治疗组,差异有统计学意义(P<0.05)。序贯治疗组患者围绝经期症状、不规则阴道出血高于单纯手术组,差异有统计学意义(P<0.05)。术后复发的独立危险因素包括既往子宫内膜异位症(endometriosis,EMs)手术史(HR=3.480,P=0.015)和囊肿为多房或分隔状(HR=2.307,P=0.049)。结论:卵巢内膜样囊肿保守手术后存在一定的复发率,既往EMs手术史、囊肿多房或分隔状是复发的独立危险因素;术后GnRHa联合口服避孕药序贯治疗方案可有效降低卵巢内膜样囊肿复发,但会并发围绝经期症状等不良反应,需引起临床重视。
Objective:To explore the preventive effect of different drug treatments on recurrence after conservative operation of ovarian endometrioid cyst(OEC),and select the optimal drug treatment.Methods:A total of 136 patients with OEC who underwent laparoscopic conservative surgery in the Affiliated Obstetrics and Gynecology Hospital,Fudan University from July 2015 to February 2017 were divided into four groups according to postoperative drug treatments:simple operation group(n=58),gonadotropin releasing hormone agonist(GnRHa)treatment group(3 cycles of GnRHa injection,n=28),contraceptives(OC)treatment group(oral contraceptive 12 months after operation,n=20),and sequential treatment group(GnRHa injection was given for 3 cycles after operation,and contraceptive was taken orally after menstruation recovered to 12 months after operation,n=30).The cumulative recurrence rate,adverse reactions of patients in each group were compared at 1,3,6,12,18,and 24 months after operation,and the influencing factors of postoperative recurrence were analyzed.Results:After the 24-month follow-up,23 of the 136 patients had recurrence,with a recurrence rate of 16.9%.The cumulative recurrence rates of patients in simple operation group,GnRHa treatment group,contraceptive treatment group,and sequential treatment group were 28.3%,28.1%,15.0%,and 3.3%,respectively,and the median recurrence-free interval was 27.37,25.89,29.47,and 30.16 months,respectively.The cumulative recurrence rate 24 months after operation in the sequential treatment group was significantly lower than that in the simple operation group and GnRHa treatment group(P<0.05).The incidences of peri-menopausal symptoms,irregular vaginal bleeding in sequential treatment group were significantly higher than those in simple operation group.The independent risk factors of postoperative recurrence included the history of previous EMs surgery(HR=3.480,P=0.015)and the multilocular or septate cyst(HR=2.307,P=0.049).Conclusions:There is a certain recurrence rate after conservative operation
作者
张晨云
卢媛
ZHANG Chen-yun;LU Yuan(Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200001, China)
出处
《中国临床医学》
2020年第5期742-749,共8页
Chinese Journal of Clinical Medicine
基金
上海市卫生和计划生育委员会面上项目(201540224).
关键词
卵巢内膜样囊肿
保守性手术
口服避孕药
促性腺激素释放激素激动剂
复发
ovarian endometrioid cyst
conservative surgery
oral contraceptive
gonadotropin releasing hormone agonists
recurrence
