Clinical Value Of Laparoscopic Conservative Operations Combined With GnRH-a On Treatment Of Moderate And Severe Ovarian Endometriosis

Objectives: to explore the clinical value of GnRH-a by analyzing the efficiency ofGnRH-a treatment for moderate and severe endometriosis after laparoscopicconservative operations.Method: choose286females who accepted laparoscopic conservative operation atDalian Female Health Hospital from Jan.1st2008to Dec.30th2009, as objects, confirmedby pathology for ovarian endometriosis cyst, according to the1985United Statesfertility association r-AFS fixed standard with moderate and severe cases,in phase IIIand Ⅳ,47patients with fertility desire, aged21to49years old, an average of32.3+/-3.6years old, according to whether use the drug and auxiliary species, thepostoperative cases were divided into3groups,106treated with GnRH-a,78treatedwith gestrinone and102without endocrinal therapy, according to using postoperativemedication3months and6months again, were divided into treatment group wereGnRH-a group3months in64cases, GnRH-a group of6months in31cases; gestrinonegroup of3months in38cases, and gestrinone group of six months in30cases.allpatients were followed up for2years, observe drug clinical effects,remissionrate,improvement rate, recurrence,preganancy outcomes and side effects.Result:1）Untreated group has a response rate of52.9%and improvement rate of19.6%.For GnRH-a three-month group,the response rate is64.1%and improvement rateis18.7%. For GnRH-a six-month group, the response rate is83.9%and theimprovement rate is6.5%.For gestrinone three-month group, the response rate is60.5%and the improvement rate is21.1%. For gestrinone six-month group, the response rate is73.3%and the improvement rate is16.7%.There were no statistic differences ofresponse rate and improvement rate between GnRH-a three-month group, gestrinone three-month group and untreated group(P>0.05). Compared with untreated group,GnRH-a six-month group and gestrinone six-month group have evidently differentresponse rate while similar improvement rate statistically(P<0.05). GnRH-athree-month group and six-month group have statistic differences between response rateand improvement rate(P<0.05). Gestrinone three-month group and six-month grouphave no statistic differences in response rate and improvement rate(P>0.05). GnRH-asix month group have differences in response rate statistically(P<0.05) while nodifferences in improvement rate statistically compared with gestrinone six-monthgroup(P>0.05). There were no difference between GnRH-a six-month group andgestrinone six-month group on both response rate and improvement rate.2） Untreated group has a recurrence rate of27.5%. For GnRH-a three-monthgroup,the recurrence rate is12.7%. For GnRH-a six-month group, the recurrence rate is9.7%.For gestrinone three-month group, the recurrence rate is18.4%. For gestrinonesix-month group, the recurrence rate is10.0%.There were statistical differences ofrecurrence rate between GnRH-a three-month group, GnRH-a six-month group,gestrinone six-month group and untreated group (P<0.05). And gestrinone six-monthgroup has no statistic difference compared with untreated group(P>0.05). There are nostatistic differences between GnRH-a three-month group and six-month group inrecurrence rate(P>0.05). And gestrinone three-month group has no statistic differencescompared with six-month group(P>0.05). There were no statistic differences ofrecurrence rate between GnRH-a three-month group, gestrinone three-month group andgestrinone six-month group(P>0.05). Compared with gestrinone three month group andgestrinone six-month group, GnRH-a six-month has no statistic differences ofrecurrence rate(P>0.05). The average recurrence times of GnRH-a three-month group,GnRH-a six-month group, gestrinone six-month and untreated group have statisticdifferences respectively(P<0.05). Compared with untreated group, the averagerecurrence times of gestrinone three-month has no statistic differences.3）The pregnancy rate of GnRH-a group (8/21) is38.1%, and gestrinone(4/11) is36.4%, untreated rate(4/15) is26.7%. There were no statistic differences (P>0.05).4）The incidence of symptoms in menopause of GnRH-a group is50.5%. And theincidence of symptoms in menopause of gestrinone group is16.2%. While patients ofthe two groups have symptoms such as symptoms in menopause, abnormal bleeding invagina, acne and side-effect of aminotransferase. The numbers have statisticaldifferences (P<0.05). Conclusion:1） After laparoscopic operation, GnRH-a three-month group andgestrinone three-month group have not raised response rate and improvement rate ofpatients evidently.While GnRH-a six-month and gestrinone six-month group haveincreased response rate evidently. GnRH-a six-month group has better clinicalconsequences than GnRH-a three-month group.2） After laparoscopic operation,gestrinone three-month group has not decreased recurrence rate,GnRH-a three-monthgroup, GnRH-a six-month group and gestrinone six-month group have decreasedrecurrence rate.3） After laparoscopic operation, GnRH-a and gestrinone have notraised the pregnancy rate among the infertilities.4） After laparoscopic operation, thetherapeutic effects of GnRH-a has better than gestrinone. And GnRH-a has less sideeffects than gestrinone.