生殖医学杂志

目的 探讨Ⅰ～Ⅲ期卵巢型及腹膜型子宫内膜异位症(EMs)患者术后的预防复发方案，为患者术后药物治疗选择提供参考。方法 回顾性分析2020年6月至2024年4月青岛大学附属妇女儿童医院收治的Ⅰ～Ⅲ期卵巢型及腹膜型EMs术后且暂无生育需求的80例住院患者的临床资料，根据术后用药方案不同分为研究组[术后放置左炔诺孕酮宫内节育系统(LNG-IUS),n=42]和对照组[术后口服短效避孕药屈螺酮炔雌醇片(Ⅱ),n=38]。比较两组患者的痛经、性交痛、盆腔痛视觉模拟量表(VAS)评分、血清糖类抗原125(CA125)水平、术后复发率及不良反应发生情况。结果 两组患者的一般资料比较无显著性差异(P>0.05)。研究组术后3个月、6个月、12个月的痛经、性交痛、盆腔痛VAS评分均显著低于对照组(P均<0.05);研究组术后6个月、12个月血清CA125水平显著低于对照组[(30.08±6.37)U/ml vs.(36.25±6.82)U/ml、(21.26±5.98)U/ml vs.(25.37±6.18)U/ml,P均<0.05];研究组术后12个月治疗总有效率显著高于对照组(92.86%vs. 76.32%,P<0.05);研究组术后12个月总复发率显著低于对照组(7.14%vs. 23.68%,P<0.05);两组间的不良反应发生率比较无显著性差异(11.90%vs. 15.79%,P>0.05)。结论 相较于口服避孕药，Ⅰ～Ⅲ期卵巢型及腹膜型EMs患者术后放置LNG-IUS能提高临床疗效，改善疼痛症状，降低术后复发率，患者预后较好。

Objectives:To explore the postoperative prevention strategies for recurrence of stage Ⅰ-Ⅲ ovarian and peritoneal endometriosis(EMs),aiming to provide a reference for the selection of postoperative drug treatment for patients.Methods:A retrospective study was conducted to analyze the clinical data of 80 inpatients with stage Ⅰ-Ⅲ ovarian and peritoneal EMs and without immediate fertility needs after surgery in Women and Children's Hospital of Qingdao University from June 2020 to April 2024. The patients were divided into the study group(n=42) and the control group(n=38) based on different postoperative medication regimens. Patients in the study group underwent levonorgestrel intrauterine system(LNG-IUS) insertion after the operation, while those in the control group received short-acting contraceptive pill of Drospirenone and Ethinylestradiol Tablets(Ⅱ) after the operation. The dysmenorrhea, pain during sexual intercourse, pelvic pain visual analogue scale(VAS) scores, serum carbohydrate antigen 125(CA125) level, postoperative recurrence rate and adverse reactions occurrence were compared between the two groups.Results:There were no significant differences in general characteristics between the two groups(P>0.05). The VAS scores for dysmenorrhea, sexual pain and pelvic pain at 3,6 and 12 months after surgery in the study group were all significantly lower than those in the control group(all P<0.05). The serum CA125 levels at 6 months [(30.08±6.37) U/ml vs.(36.25±6.82) U/ml, P<0.05] and 12 months [(21.26±5.98) U/ml vs.(25.37±6.18) U/ml, P<0.05] after surgery in the study group were significantly lower than those in the control group. The total effective rate of treatment in the study group at 12 months after surgery was significantly higher than that in the control group(92.86% vs. 76.32%,P<0.05). The total recurrence rate at 12 months after surgery in the study group was significantly lower than that in the control group(7.14% vs. 23.68%,P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(11.90% vs. 15.79%,P>0.05).Conclusions:Compared with oral contraceptives, the insertion of LNG-IUS after surgery for stage Ⅰ-Ⅲ ovarian and peritoneal EMs can enhance clinical efficacy, alleviate pain symptoms, reduce the recurrence rate after surgery, and improve the prognosis of patients.