Research About Clinical Efficacy Of Combined GnRHa Therapy After Conservative Laparoscopic Operation And Recurrence-related Factors Of Endometriosis

Objective:To investigate the clinical efficacy of adjuant treatment with gonadotropin-releasing-hormone agonist(GnRHa) following conservative laparoscopic operation and recurrence-related factors of endometriosis.Method:Choosed180Patients who accepted laparoscopic conservative operation at Qi Lu Hospital of Shan Dong university from June2009to June2012, as objects, confirmed by pathology for ovarian endometriosis cyst with or with or other type of endometriosis. Subsequent follow-up of the surviving patients was performed until the end of July2014,180cases can follow up, missing rate is18.18%, all cases were followed up for2years.According to the American Fertility Society stages law in1985(r-AFS),all the cases wrer divided into different stages. According to whether postoperative use of GnRHa and the length of medication cycle, the cases were divided into3groups, surgery alone group in90cases, GnRHa3-month group in54cases, GnRHa6-month group in36cases, observed all cases’s symptom remission and improvement rate, recurrence rate and pregnancy outcomes, comparatively studied the clinical data of relapsed and non-relapsed cases, to analyze the recurrence-related factors of endometriosis with statistical methods. Results:①Surgery alone group had a remission rate of38.9%and improvement rate of61.1%. For GnRHa3-month group, the remission rate of52.4%and improvement rate of47.6%. For GnRHa6-month group, the remission rate of 73.3%and improvement rate of26.7%.Compared with surgery alone group and GnRHa3-month group, GnRHa6-month group had statistical differences upon remission and improvement rate (P<0.05). There was ano statistically difference of remission rate and improvement rate between GnRHa3-month group and surgery alone group(P>0.05).②The overall recurrence rate, first-year recurrence rate and second-year recurrence rate were17.8%,11.1%,6.6%in surgery along group and11.1%,5.6%,5.6%in GnRHa3-month group and5.6%,2.7%,2.7%in GnRHa6-month group. The average time to relapse was13.26±3.12(month) in surgery along group and14.74±2.39(month) in GnRHa3-month group and18.47±4.85(month) in GnRHa6-month group. there were statistical differences in overall recurrence rate, first-year recurrence rate,second-year recurrence rate and the average time to relapse of GnRHa6-month group when compared with GnRHa3-month group and surgery alone group(P<0.05). GnRHa3-month group had no statistically differences in overall recurrence rate, first-year recurrence rate, second year rate and the average time to relapse when compared with surgery along group(P>0.05).③Of surgery alone group,39cases suffered the complication of infertility, while33cases in GnRHa3-month group and12cases in GnRHa6-month group. The overall pregnancy rate, first-year pregnancy rate and second-year pregnancy rate were30.8%,17.9%,12.8%in surgery along group and30.3%,18.2%,12.1%in GnRHa3-month group and41.6%,16.7%,25.0%in GnRHa6-month group. There were no statistical difference in overall pregnancy rate, first-year pregnancy rate and second-year pregnancy rate among three groups.(P>0.05).④During the follow-up,24cases relapsed, while156cases with no recurrence. Univariate analysis of clinical data found that there were no significant difference of age, age at menarche, age at first birth, preoperative use of anti-endometriosis medication, preoperative gravidity/parity, severity of dysmenorrheal, preoperative level of CA-125, r-AFS stage, duration of disease, type of endometriosis(simple/mixed),size of lesions between relapsed and non-relapsed patients(P>0.05),while have significant differences at previous endometriosis-related surgery, intrauterine operating history, side of lesion(bilateral), postoperative use of GnRHa and postoperative pregnancy(P<0.05). Multivariate logistic regression analysis showed that previous endometriosis-related surgery, intrauterine operating history, side of lesion(bilateral)are risk factors,of endometriosis recurrence, while postoperative use of GnRHa and postoperative pregnancy protective factor.Conclusion:①Laparoscopic conservative combinated with adjuant use of GnRHa can effectively improve the clinical symptoms, prevention of recurrence, delay the time to relapse, but have no effect on improving postoperative pregnancy rate of endometriosis.②previous endometriosis-related surgery, intrauterine operating history, side of lesion(bilateral)are risk factors,of endometriosis recurrence, clinical follow-up should be strengthened in patients with risk factors and individualized treatment plans based on the specific circumstances of those patients should be develop. Postoperative pregnancy is a protective factor for recurrence of endometriosos,for patients who have fertility requirements, whether or not accompanied by infertility, should seek pregnancy as soon as possible after surgery, assisted reproductive technology should be adopted,when necessary, to increase the chances of pregnancy.