| Objective:Ovarian endometriosis is a common disease in gynecology,and its main treatment is laparoscopic surgery,which is prone to recurrence after surgery,so postoperative drug assisted treatment is needed to reduce its recurrence.This study by comparing laparoscopic ovarian endometriosis patients postoperative gonadotropin-releasing hormone agonist treatment 2 period of treatment,3 period of treatment,features four and five or six cycles of recurrence,pain relief,pregnancy,perimenopausal symptoms and reverse add situation,analysis of postoperative use different gonadotropin-releasing hormone agonist treatment efficacy and side effects,investigate the best treatment of postoperative line gonadotropin-releasing hormone agonist treatment option.Methods:A total of 208 patients with ovarian endometriosis who were admitted to the gynecology department of the people’s hospital of guangxi zhuang autonomous region from January 2015 to December 2017 and underwent laparoscopic surgery and met the inclusion and exclusion criteria were collected.The patients were followed up for 2-3 years,and 183 patients were followed up successfully.All patients received hypodermic injection of gonadotropin-releasing hormone agonist 2 to 4 days after the operation or 1 to 3 days after the first menstrual period.Grouping :(1)patients were divided into 2 treatment groups,3 treatment groups,4 treatment groups,and 4 treatment groups according to the actual postoperative treatment courses.(2)according to the length of postoperative medication,the patients were divided into the short-course group(1-3 courses of GnRH-a treatment)and the long-course group(4-6 courses of GnRH-a treatment).The recurrence rate,pain relief rate,pregnancy rate,adverse reaction rate and reverse addition rate were compared in each group by analyzing the basic clinical data and follow-up data.Results:(1)Overall efficacy of all patients: a.Recurrence rate:Thirty-eight patients relapsed,with a total recurrence rate of 20.8%,3 cases(1.6%)of recurrence within 6 months after surgery,6patients(3.3%)with recurrence within 6 months to 1 year after surgery,12 patients(6.6%)with recurrence within 1 year to 2 year after surgery,17 cases(9.3%)of recurrence after 2year.The rate of recurrence was highest 2 years after surgery.b.Pain relief:There were 137 patients with pain before the operation,among which 104 had pain relief after treatment,the total rate of pain relief was 75.9%.c.Pregnancy status:Preoperative infertility history and a total of 74 patients with postoperative have fertility requirements,9 cases of patients after in vitro fertilization and embryo transplantation pregnancy,39 cases with natural pregnancy,total natural pregnancy rate of 52.7%,after half a year,half an year or 1 years after operation,1 year or 2 years after surgery and postoperative 2 years the number of natural pregnancy were 8 cases(10.8%),21 cases(28.4%),10 cases(13.5%),and 0 cases.Most of the 4 groups were pregnant within 6 months to 1 year after surgery.Natural pregnancies result in miscarriage of 6 patients with pregnancy,8 cases of premature and term birth 24 cases.d.Adverse reaction:Among the 65 patients with perimenopausal symptoms,hot flashes,sweating,mood fluctuations,and decreased sexual quality were common side effects,and bone and joint pain,depression,coagulation,and insomnia were less common.The total incidence of side effects was 36.1%.e.Add-back:A total of 26 patients were treated with reverse drug addition after the onset of perimenopause.(2)According to its actual postoperative courses are divided into two treatment groups,three treatment groups,the four treatment groups,more than four treatment groups:a.Recurrence:There was no statistically significant difference in the cumulative recurrence rate of the 4 groups with different treatment courses at 2-3 years after surgery(P>0.05).Pairwisecomparison was conducted among the four groups: there was no statistically significant difference in the cumulative recurrence rate between the two treatment groups and the three treatment groups and the four treatment groups(P>0.05).The cumulative recurrence rate of the two treatment groups was higher than that of the four treatment groups,and the difference was statistically significant(P<0.05).The cumulative recurrence rate of the three treatment groups was higher than that of the four treatment groups,and the difference was statistically significant(P<0.05).The cumulative recurrence rate of the group with more than four courses of treatment was not significantly different from that of the group with hree courses of treatment and the group with four courses of treatment(P>0.05).b.Pain relief:There was no statistical difference in the pain relief rate between the four groups with different medication courses(P>0.05).Pairwise comparisons were made between the four groups:There was no statistically significant difference between the two treatment groups and the three treatment groups,the four treatment groups and the more than four treatment groups(P>0.05).The pain relief rate in the four treatment groups and the group with more than four treatment courses was higher than that in the three treatment groups,and the differences were statistically significant(P<0.05).There was no significant difference between tthe four treatment groups and the more than four treatment groups(P>0.05).c.Pregnancy status:There was no statistically significant difference in the cumulative pregnancy rate of four different drug courses(P>0.05).There was no statistically significant difference in the cumulative pregnancy rate between the four groups(P>0.05).(3)According to the length of postoperative drug courses,the patients were divided into the short-course group and the long-course group: a.recurrence rate: compared with the post-treatment recurrence rate of the long-course group and the short-course group,the recurrence rate of the long-course group was lower than that of the short-course group,and the difference was statistically significant(P<0.05).b.Pain relief: the post-treatment pain relief rate of the long course and short course group was higher than that of the short coursegroup,and the difference was statistically significant(P<0.05).c.Pregnancy status: there was no statistically significant difference in post-treatment pregnancy rate between the long and short course groups(P>0.05).(4)The patients were divided into 4 groups according to the actual postoperative course of medication(the same as the above group): there was no statistically significant difference in the incidence of side effects between the 4 treatment groups(P>0.05).Four groups of patients with different drug treatment carries on the contrast between two groups: the incidences of adverse events to two period of treatment respectively with three treatment group compared with the four treatment groups,there were no statistically significant difference(P>0.05);The incidence of side effects in the 2 treatment groups was lower than that in the 4 treatment groups,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of side effects between the three treatment groups,the four treatment groups and the four treatment groups(P>0.05).There was no statistically significant difference in the reverse addition rate between the four groups(P>0.05),and there was no statistically significant difference in the reverse addition rate between the four groups(P>0.05).Conclusion:(1)Patients with ovarian endometriosis who received 4 courses of gonadotropin-releasing hormone agonist treatment after surgery had higher pain relief rate and lower recurrence rate compared with 3 courses.In addition,a long course of gonadotropin-releasing hormone agonist treatment(4-6 courses)has a higher pain relief rate and a lower recurrence rate than a short course of gonadotropin-releasing hormone agonist treatment(1-3 courses),4 courses of gonadotropin-releasing hormone agonist treatment after laparoscopic surgery may be more economical and effective,with fewer side effects and better compliance.(2)There was no significant difference in the efficacy of four different courses of gonadotropin-releasing hormone agonist in improving pregnancy in patients with ovarian endometriosis and infertility,but the number of postoperative pregnancies decreasedwith the extension of postoperative time,and the optimal time of pregnancy was between half a year and one year after the operation.The 4 courses of treatment of gonadotropin-releasing hormone agonist were of moderate length after surgery,and the optimal gestation time was not easily missed.(3)The incidence of side effects in patients with ovarian endometriosis after 5-6 courses of gonadotropin-releasing hormone agonist treatment was significantly higher than that of 2 courses,and the longer the course of medication was,the higher the incidence of perimenopausal symptoms was. |
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