Clinical Observation Of Laparoscopic Operations Combined With Different Drugs On Treatment Of Ovarian Endometriosis

Objective:Endometriosis is a gynecological diseases which can bleed periodically when the activity endometrial tissue (glands and stromal) lies outside the uterine body. In recent years, the incidence of endometriosis has an upward trend. The syndrome caused by endometriosis such as dysmenorrhea, lower abdominal pain and sexual intercourse pain, is a serious impact on women's health and quality of life, also is a major cause of infertility. The pathogenesis of the disease is unclear, the lesions of the diseases are extensive, the form of the disease is diverse, and the diseases also has malignant biological behaviors such as invasion, metastasis and recurrence , with a character that is easy to relapse after treatment,the disease is also a common refractory disease. The ovarian endometriosis (ovarian chocolate cyst ) is the most comment type , the incidence accounts for it about 20% -40%.The treatment principles of endometriosis is to eliminate disease focus, to improve and promote fertility, and to reduce recurrence. The patients who has requirements of reproduction or are infertility, need to return to normal physiological and anatomical environment, and to increase the pregnancy rate. Surgical treatment is the basic treatment of endometriosis. At present, whether in foreign or domestic country laparoscopic surgery has been widely used to treat endometriosis. Surgery modes include conservative surgery, semi-conservative surgery and radical surgery. For the ovarian endometriosis patients who are at the period of child-bearing age, the current surgical method is the basic conservative surgery, which needs to retain ovarian, it belongs to non-radical surgery, the recurrence rate after surgery alone is as much as 40%. For a long time, the recurrence rate after conservative treatment has been plagued clinical obstetrics and gynecology physician, how to reduce the relapse rate ,how to improve the remission rate and pregnancy rate are the focuses of the study. Surgery combined with drug therapy can make lesions which can not see by the naked eye or are to deep to resect to atrophy, to degenerate ,in order to reduce the relapse rate and improve the pregnancy rate. Through observing and comparing the pregnancy rate, the remission rate and the relapse rate of 213 cases of ovarian endometriosis patients after laparoscopic conservative treatment, hope to provide a theoretical basis for drug adjuvant therapy to ovarian endometriosis patients after conservative treatment. The conservative treatment concludes to no use of drug, using Gestrinone for adjuvant therapy, and using Zoladex drug to adjuvant therapy .Methods:Collected ovarian endometriosis patients that take laparoscopic conservative surgery in the First Clinical Hospital of Jilin University, the Second Clinical Hospital of Jilin University and the Third Clinical Hospital of Jilin University were 213 cases, from January 2004 to January 2007 ,all cases can complete follow-up. According to the American Fertility Society stages law in 1985(R- AFS), all cases are divided into different stages,Ⅰperiod,Ⅱperiod of 87 cases,Ⅲperiod of 66 cases,Ⅳperiod 60 cases, including a total of 43 cases of infertility patients.Of all cases are women of reproductive age, from 18-year-old to 40-year-old, with an average age 32.5.All the patients have no surgical contraindication,without diabetes, hypertension, heart disease history, history of hormone drugs, blood examination, urine examination , liver functions and kidney functions are normal. All infertility patients of this study must meet the following conditions:①contraceptive measures are not taken, they have a normal sex life of two years and fail to pregnant;②non-ovarian surgical history, non-oviduct surgical history, without Other infertility factors;③husband's semen examination are normal;④age 25-33 years old. Age of patients in different groups and the combined number of infertility cases are no statistical difference. (P>0.05). All patients'laparoscopic conservative surgery(ovarian endometrioma stripping surgery) were performed by Deputy director of physicians or Chief physician with experience, and confirmed by pathology for ovarian endometriosis. In accordance with the patient's condition and their own wishes, all cases are divided into 3 groups, non-drug treatment group (A group), Gestrinone group (Beijing Zizhu Pharmaceutical Co., Ltd.) (B group), Zoladex group (AstraZeneca Pharmaceutical Co., Ltd.) (C group).A group patients are not treated with drugs after operation; from the the first week of menstruation,B group patients take Gestrinone capsules 2.5mg, twice a week ; from the first day of menstruation ,C group inject Zoladex 3.6 mg, once every four weeks. Patients of I period and II period take medicine for 3 months, Patients of III period and IV period take medicine for 6 months.After drug treatment period, infertility patients are given to the treatment of LRH,monitoring of follicle,and guide pregnancy after restoration of menstruation. All cases were followed up for 24 months, mainly about their symptoms remission, recrudescence and pregnancy situation. Taking remission rate of symptoms , relapse rate and the cumulative pregnancy rate as index, comparing these indicators of changes in each group is statistically different or not.Results: 1. symptom remission rate: after surgery ofⅠ,Ⅱperiod patients ,the symptom remission rate of A group(60.98%) was significantly lower than B,C groups(χ2A-B=5.30,χ2A-C=4.17 , P<0.05), and has statistical significance ; the symptom remission rate of B is 86.20%, C group is 88.23%, between the two groups there is no significant difference (χ2=0.00,P> 0.05). The symptom remission rate ofⅢperiod patients at A group was 30.00%, significantly lower than B,C groups(χ2A-B=4.10,χ2A-C=14.52,P <0.05), also has statistical significance; B, C group symptom remission rates were 60.87%, 86.95%, between the two groups ,there is significant difference(χ2B-C=4.06,P﹤0.05). The symptom remission rate ofⅣperiod patients at A group is 20.00%, significantly lower than B,C groups(χ2A-B=4.11,χ2A-C=15.20,P <0.05), also has statistical significance; B group rate is 50.00%, C group recurrence rate is 83.33%, there is no significant difference between B and C (χ2 B-C=4.84,P <0.05).2. The relapse rate: after surgery ofⅠ,Ⅱperiod patients , the recurrence rate of A group(56.09%) was significantly higher than B,C groups(χ2A-B=4.30,χ2A-C =7.18,P<0.05), and has statistical significance; B group recurrence rate was 21.03%, C group recurrence was 17.65%, the difference between B and C groups has no statistical significance (χ2B-C=0.42,P﹥0.05). The recurrence rate ofⅢperiod patients at A group was 70.00%, significantly higher than B,C groups(χ2A-B=4.10,χ2A-C=14.52,P <0.05), also has statistical significance; B, C group recurrence rates were 39.13%, 13.04%, there is a significant difference between B and C(χ2 B-C=4.06,P <0.05). The recurrence rate ofⅣperiod patients at A group was 75.00%, significantly higher than B,C groups(χ2A-B=4.97,χ2A-C =8.47,P <0.05), also has statistical significance; B group recurrence rate is 40.91%, C group recurrence rate is 27.78%, there is no significant difference between B and C (χ2 B-C=0.75,P> 0.05).3. pregnancy rate: after 2 years of surgery, A group has 4 cases of pregnancy, and is the lowest pregnancy rate at 30.77%, and significantly lower than B, C group (compared A group and B group ,P=0.47,<0.05 ; compared A group and C group P=0.33,﹤0.05) with statistical significance; B group has 9 cases of pregnancy , the pregnancy rate was 75.00%; C group has 13 cases of pregnancy, the pregnancy rate was 72.22%, There is no significant difference between the two groups (P=1.00,>0.05).4. Drug side effects: Gestrinone group is higher than Zoladex group at the incidence of vaginal bleeding, the difference was significant (χ2=24.74,P < 0. 05); the two groups all has weight gain.The weight gain difference between the two groups is not significant (χ2=2.46,P > 0. 05); the ratio of increased transaminase in two groups has a significant difference (χ2=18.60,P < 0. 05), in gestrinone group the incidence of liver dysfunction is higher. The common symptom in gestrinone group is acne, and hot flashes and other side effects of low estrogen in Zoladex group, the difference was no significant (χ2=0.38,P﹥0. 05). The side effects in two groups are minor, in gestrinone group after stop drug of 1 ~ 6 months symptoms return to normal, in Zoladex group after stopping drug of 1 ~ 2 months symptoms return to normal.Conclusion: 1 For ovarian endometriosis patients which are at the period of child-bearing nage after conservative treatment with laparoscopic, using Gestrinone, Zoladex drug can significantly improve the pain symptoms of endometriosis patients, reduce relapse rate, improve the pregnancy rate.2 For the patients of endometriosis at stageⅠ,Ⅱperiod , laparoscopic operation can be inexpensive and convenient gestrinone treatment can effectively alleviate the symptoms, reduce relapse. The treatment effect compared with Zoladex group has no significant differences; and for patients at stageⅢ,Ⅳby laparoscopic surgery to remove ectopic lesions use Zoladex drug compared with using Gestrinone drug can more enhance the effectiveness of treatment and control recurrence.3. The side reaction of group Gestrinone is mainly in the effect of liver function and high androgen symptoms, after stopping drugs of 1 ~ 6 months ,the symptoms return to normal. The side reaction of Group Zoladex is mainly on low-estrogen symptoms. After stopping 1 ~ 2 months of the drug, the side symptoms return to normal. The patients of the two drugs group are better compliant.