Clinical Observation Of GnRH-a Combined With Oral Contraceptive Long-term Sequential Therapy In Improving Recurrence Of Moderate And Severe Ovarian Endometriosis After Laparoscopic Conservative Surgery

Objective:To investigate the clinical effect of GnRH-a combined with oral contraceptive long-term sequential therapy on patients with moderate and severe ovarian endometriosis after laparoscopic conservative surgery,and to provide evidence for clinical treatment.Methods:From January 1,2014 to January 1,2016,158 patients with ovarian endometriosis were treated by laparoscopic conservative surgery in Jiangxi Provincial Maternal and Child Health Hospital.According to the 1985 r-AFS criteria,all the patients were classified as stageⅢ~Ⅳendometriosis,150 cases were followed up,the follow-up rate was 94.94%.According to the actual situation after the operation,they were divided into three groups.Group A(46 cases)were treated with GnRH-a after operation and continued with long-term sequential oral contraceptive therapy.Group B(73 cases)were treated with GnRH-a only.In group C,31 patients were treated with surgery only and no supplementary medication was added after the operation.All the patients were followed up for 24~48 months,and the basic clinical data were collected for general data analysis.Measurement data were analyzed by one-way ANOVA and rank sum test.Counting data were analyzed by?~2 test or Fisher’s exact test.Survival analysis was performed by Kaplan-Meier analysis.p<0.05 was considered statistically significant.Results:1.There were no difference among the group A,B,and C in terms of age of operation,number of previous pregnancies,number of previous births,serum CA125,r-AFS stage,cyst side,number of preoperative pain and the follow-up time(p>0.05).2.A total of 150 patients were followed up,18 cases of them were relapsed.There were 1 case in group A,10 cases in group B,as well as 7 cases in group C of all those relapsed patients.According to the criterion of recurrence,recurrent cases can present with multiple symptoms or signs at the same time.Among the recurrent patients,there were 9 recurrent cases of chronic pelvic pain such as dysmenorrhea and intercourse pain,3 cases of pelvic tenderness nodules,18 cases of new ovarian endometriosis cysts with diameter larger than 3 cm,and 4 cases of the increasing serum CA125 levels.3.The mean follow-up time of 150 patients was(36.75±6.19)months.In group A,only one patient recurred,and the recurrence time was 32 months postoperatively,while the cumulative recurrence rate was 2.56%.The average recurrence time and median recurrence time in group B were 17 months postoperatively and the cumulative recurrence rate was 14.70%.In group C,the average recurrence time was9.6 months postoperatively,the median recurrence time was 3 months postoperatively,and the cumulative recurrence rate was 24.40%.The overall Log-Rank test was used to compare the cumulative recurrence rate among the three groups,and the differences were statistically significant(?~2=8.058,p<0.05).In addition,at 3 months postoperatively,there was no recurrence in group A and B,and the cumulative recurrence rate were 0.In group C,4 patients recurred and the cumulative recurrence rate was 12.90%.The differences among the three groups were statistically significant(p<0.05),and the cumulative recurrence rate in group C was significantly higher than that in group A and B(p<0.05).From 36 to 48 months postoperatively,the cumulative recurrence rate of all three groups were 0.4.As the paired Log-Rank test for cumulative postoperative recurrence rates among the three groups of patients shown,the cumulative recurrence rate in group A was significantly lower than that in group C(?~2=8.404,p<0.01),the cumulative recurrence rate in group A was significantly lower than that in group B(?~2=4.643,p<0.05),and the cumulative recurrence rate in group B was not significantly lower than that in group C(?~2=1.423,p>0.05).Conclusions:1.After laparoscopic conservative surgery,GnRH-a combined with oral contraceptive long-term sequential therapy can not only reduce the short-term recurrence rate 3 months after operation,but also reduce the long-term recurrence rate of 48 months after surgery in patients with moderate and severe ovarian endometriosis,as well as delay the recurrence of moderate and severe ovarian endometriosis.2.After laparoscopic conservative surgery,GnRH-a alone can only reduce the short-term recurrence rate at 3 months postoperatively of patients with moderate or severe ovarian endometriosis,but it is not effective in reducing the long-term recurrence rate of 48 months after operation.