Clinical Observation Of Different Adjuvant Therapy After Laparoscopic Excision Of Ovarian Endometriosis Cyst In Women Of Childbearing Age

Objective:ovarian endometriosis and ovarian endometriosis cyst（OEM）of childbearing age patients with no family planning and surgical indication for 1 year were removed by laparoscopic OEM.Different adjuvant treatments were used after surgery to analyze the curative effect.Methods:A total of 105 OEM patients of childbearing age who were admitted to our hospital from September 2020 to June 2022 and underwent laparoscopic cyst removal within 1 year without family planning were selected.The subjects were random number table method divided into three groups with random number table method:drospirenone estradiol tablets（Ⅱ）group,drodrogestrel group,levonorgestrel intrauterine birth control sustained-release system（levonorgestrel）intrauterine birth control sustained-release system（LNG-IUS）group,with 35 patients in each group.Drospirenone estradiol tablets（Ⅱ）were given oral drospirenone estradiol tablets（Ⅱ）after laparoscopic OEM removal.From the first day of the first postoperative menstrual period,one tablet（3mg drospirenone,0.02mg ethinylestradiol）qd was taken orally.After 28 days,the next cycle of drug therapy was continued for a total of 6 menstrual cycles;Dydrogesterone group was given oral dydrogesterone treatment after laparoscopic OEM elimination,from the 5th day to the 25th day of the first postoperative menstruation,10mg Bid,and the above medication time and method were repeated in the next menstrual cycle,for a total of6 menstrual cycles.LNG-IUS group was given LNG-IUS intrauterine treatment after laparoscopic OEM elimination,which was placed on the fourth day of the first postoperative menstruation and taken out when the study subjects had the need of pregnancy.For six months of follow-up,including to bend progesterone group for unplanned pregnancy interruption followed up in 1 case,LNG-IUS back due to accidental removal of birth control systems group in 1 case.The study investigated whether there were differences in the efficacy of three different adjuvant treatments on dysmorrhea,whether there were differences in ovarian reserve function after the use of adjuvant therapy,and whether there were differences in the incidence of adverse reactions among the three groups.Results:1.Visual analogue scale（VAS）in the first postoperative menstruation of the three groups were statistically analyzed,with no difference（P>0.05）.Compared with before adjuvant therapy,the VAS score in drospirenone estradiol tablets（Ⅱ）group,dydrogesterone group and LNG-IUS group was significantly decreased（P<0.05）,which was statistically significant;Statistical analysis of VAS score in dydrogesterone group and LNG-IUS group was conducted respectively compared with drospirenone estradiol tablets（Ⅱ）group,and there was no significant difference（P>0.05）.The statistical results showed that VAS score could be improved after three kinds of adjuvant therapy,but there was no significant difference in dysmenorrhea improvement among the three kinds of adjuvant therapy.2.The AMH,E₂,FSH and LH of the three groups of subjects on the third day after the first postoperative menstruation were statistically analyzed,and the results showed no difference（P>0.05）.The values of AMH,E₂,FSH and LH in drospirenone estradiol tablets（Ⅱ）group there and six months after surgery were significantly lower than those after surgery（P<0.05）,indicating statistical significance.The values of AMH,E₂,FSH and LH in drogesterone group and LNG-IUS group there and six months after surgery were significantly lower than those in the first group after surgery There was no significant difference at the time of menstruation（P>0.05）,and there was no statistical significance.3.Within half a year of follow-up,the incidence of adverse reactions was 8.56%in drospirenone estradiol tablet（Ⅱ）group,26.46%in drogesterone group,and 29.40%in LNG-IUS group.The incidence of adverse reactions in drospirenone estradiol tablets（Ⅱ）group after receiving adjuvant therapy was significantly lower than that in drogesterone group and LNG-IUS group（P<0.05）,which was statistically significant.4.After six months of follow-up,there were no recurrence cases in drospirenone estradiol tablets（Ⅱ）group,drogesterone group and LNG-IUS group.Conclusion:For OEM patients of childbearing age who had no birth plan within one year and had indications of surgery,oral treatment of dropirone estradiol tablets（Ⅱ）after laparoscopic ovarian cyst removal was significantly effective in improving dysmenorrhea symptoms,and had fewer side effects compared with the other two groups.At the same time,it can inhibit the development and consumption of follicles so that the ovarian reserve function is protected.Therefore,if women of reproductive age do not have a birth plan within one year,and OEM has surgical indications,dropirosterone estradiol tablets（Ⅱ）can be selected as an auxiliary therapy after laparoscopic culling.