Clinical Observation Of Laparoscopic Surgery Combined Gnrh-a Treatment Of Ovarian Endometriosis

Objective：Endometriosis (EM), a common gynecological disease, canoccur at multiple sites, of which the most common is ovarian. Ovarianendometriosis (OE),also known as endometrial cyst of ovary,is becomeing amodern,frequently-occurring disease because of the gradually rising incidencerate.The main clinical symptoms of OE are dysmenorrhea, sterility, sexualdiscomfort and so on.Fertility sparing laparoscopic surgery,a minimallyinvasive operation, in which diagnosis and treatment as a whole, plays a moreand more important role in the diagnosis and treatment of OE.The fertility sparing laparoscopic surgery in OE has manyadvantages,such as:small incision, less bleeding, reducing peritoneal incisionand damage, clear operation field, timely discovery and treatment of thesmall lesions, decreasing the chance of abdominal internal organs ofpostoperative adhesion, which make it the first choice. However,thepostoperative recurrence rate is about40%, which brings tremendous burdenson the social-economic and negative influences on women’s mental andphysical health.The prognosis of OE depends on many factors, such as: age ofonset, operation method, disease stage and whether there is a adjuvant therapyafter operation. Researchs have showed that:at present,laparoscopic surgerycombined with GnRH-a therapy is effective method of reducing recurrence ofOE.In currently reported in the literature，the cycle of laparoscopic surgerycombined with GnRH-a treatment without uniform standards (generallyranging from3-6cycles), side effects produced during the treatment easy toreduce patient compliance. A series of questions makes explore factors anddevelop individualized treatment programs more valuable.Through the observation of laparoscopic surgery combined withGnRH-a therapy in different ages, various onset locations (unilateral or bilateral ovarian involved), different stages,remission and recurrence ofclinical symptoms,adverse reaction during treatment.Aimed to investigate therelevance of different ages, different anatomical site and the different stageswith ovarian endometriosis prognosis, Observation the remission of clinicalsymptoms after the add-back therapy, analysis add-back therapy efficacy.Provide a theoretical basis for clinical work to develop individualizedtreatment plan based on the specific circumstances of the patient.Methods：Collected the date from September2010to September2012which after laparoscopic ovarian chocolate cyst removal surgery andpostoperative give GnRH-a there courses of drug treatment in the FourthHospital of Hebei Medical University.At the beginning of the day beforesurgery to twelve months after surgery improve the patient data.Includinggeneral, recorded of intraoperative, postoperative pathology, fill out thequestionnaire, outpatient review information, etc. Follow-up deadline isSeptember2013.A retrospectively analyzed for the104patients with completedata. According to different age groups、 different parts of onset and differentstages divided into different groups. Calculated for each group of abdominalpain remission rate, relapse rate, incidence of side effects and add-backtherapy rate. Analysis relevance of different ages, different anatomical site(unilateral or bilateral ovarian involvement) and the different stages withovarian chocolate cysts prognosis, Observation the remission of clinicalsymptoms after the add-back therapy, analysis add-back therapy efficacy.Different groups of of abdominal pain remission rate, relapse rate,incidence of side effects and add-back therapy rate after treatment was countdata, by χ2test for linear trend analysis. Comparison of clinical symptomsbetween the groups is the measurement data before and after add-backtreatment, descript by±s, analysis by paired t test. P <0.05was statisticallysignificant difference, the data analysis were using SPSS16.0statisticalsoftware.Results:1Laparoscopic surgery combined GnRH-a treatment used in the different age is to determine the efficacy of abdominal pain relieved. It isfound that the different between the two ages has no statistically significant(P>0.05);≤35years old group has less recurrence rate than>35years oldgroup. The side reaction rate of≤35years old group is higher than the>35years old group, the add-back therapy rate of≤35years old group ishigher than the>35years old group (P<0.05).2The clinical observation and treatment in different parts of onsets(unilateral and bilateral group) by using laparoscopic surgery combinedGnRH-a treatment is as follows: the confirmed efficacy of the remission of thesymptoms of abdominal pain, it is found that the different between the twoages has no statistically significant (P>0.05); The unilateral side group hasless recurrence rate than the bilateral group, the incidence of adverse eventsand the add-back therapy rate of the unilateral group are both higher than thebilateral group(P<0.05).3The clinical observation and treatment in different parts of patientwith different stages by using laparoscopic surgery combined GnRH-atreatment is as follows: The remission rate of the symptoms of abdominal painbecome lower along with the stages become higher, and the different hasstatistically significant(P<0.05). The recurrence rate become higher when thestages become high, and the different has statistically significant (P<0.05).The incidence of adverse events and add-back therapy rate of different stageshave statistically significant (P<0.05).4Compared with per-treatment, the patient is significant improved inhot perspire, bone and joint pain and sexual life after add-back therapy, andthe different has statistically significant (P<0.05), but the mood swings,vertigo and urinary tract infection symptoms have not significant improvedand the different has no statistically significant (P>0.05).Conclusion:1The effect of ovarian endometriosis after laparoscopic surgerycombined with GnRH-a treatment is not obvious in the different ages anddifferent parts of onset factors on the incidence rate of abdominal pain.with the increasesof disease stage, the abdominal pain remission rate decreasedgradually.2In ovarian chocolate cyst surgery combined use of GnRH-atreatment the recurrence rate increases with age and disease stage, whileaffecte by diseased parts,unilateral lower recurrence rate than bilateral.3Ovarian chocolate cysts after laparoscopic surgery combined withGnRH-a treatment the incidence of side effects and add-back treatment rateincrease with age, stage of disease reduce, while affecte by diseased parts, theunilateral incidence of side effects add-back therapy rate were higher thanbilateral.4The younger, unilateral ovarian involvement and the earlier stage ofthe disease patients has higher the incidence of adverse events after thelaparoscopic surgery combined GnRH-a treatment, so the add-back therapyshould be added properly.5The proper addition of add-back therapy has influence in hot perspire,bone and joint pain and sexual life, but it has no significant influence in moodswings, vertigo and urinary tract infection symptoms.