Research About Chemical Therapy Of Endometriosis And Complications After Laparoscopic Operation

Objective: To evaluate the effects of GnRHa and add-back therapy(ADT) on hypoestrogenic symptoms ,sex hormone, bone mineral density (BMD) and CA125 in the treatment of patients with endometriosis after laparoscopic operation,and the recurrence,beginning of the menstruation,pregnancy rate after stopping the chemical therapy. To investigate a new effective regimen of addback and provide a useful treatment strategy in women with endometriosis.Materials and Methods: Forty-five women with endometriosis had been diagnosed by surgery (AFS III-IV) in the first affiliated hospital to suzhou university form 2008-10 to 2009-12, consented to participate in this study. The participants were randomly assigned into three groups (15 patients each) as GnRHa trimester group (group-A) ,GnRHa six months group (group-B) and GnRHa six months with ADT group (group-C). Group-A received the injection of Goserelin Acetate (3.6 mg, i.h.) every 28 days for three times, group-B for six times, and group-C for six times besides conjugated estrogens tablets 0.3mg quaque die alterna. Before and after the treatment, the degree of pain was measured according to a visual analog scale (VAS), the menopausal symptoms were assessed with the Kupperman Menopausal Index (KMI) and bone mineral density (BMD).At the same time venous blood was collected by venipuncture to detect the level of FSH , E2 and CA125 in serum.And investigate the recurrence,duration of the menstruation, pregnancy rate after stopping the chemical therapy.Results:1. Among three groups,they had significant deviation in the KMI(F=8.22,P<0.05).Group-A and group-B,group-B and group-C had significant deviation(P<0.05).2. The E2 had decreased after subcutaneous injections GnRHa postoperative,and there were significant deviation(F=6.26,P<0.05)in the three groups.Group-A and group-B, group-A and group-C had significant deviation(P<0.05). And the BMD had the similar results,but the deviation of three groups showed F=8.51(P<0.05).The FSH of three groups had significant deviation(F=1.01,P>0.05)。3. There were moderate negative correlation between FSH and E2 levels(r=-0.68477,P<0.05),but BMD had high positive correlation (r=0.81999,P<0.01) with E2。4. The VAS between preoperative and postoperative had significant deviation(F=13.9,P<0.05).But among Group-A , group-B and group-C had no significant deviation(P>0.05).5. The rate of positive CA125 postoperative was significant lower than preoperative(P<0.05).There was no significant difference among the rate of positive CA125 in group-A,group-B,and group-C(P>0.05).6. The days of beginning menstruation after ending chemicial therapy in three groups had significant deviation(F=1.03,P<0.05).Group-A and group-B, group-B and group-C had significant deviation(P<0.05).7. There was no significant difference among the rate of recurrence in three groups after drug discontinuance(P>0.05).8. There was no significant difference between group-Aand group-B in the rate of pregnancy(P>0.05).Conclusion:1.The level of serum CA125 significantly decreased after laparoscopic operation because of EMS.The goserelin acetate had effectively suppressed the level of serum estrogenic and dysmenorrhea.But it had some side effects,like menopausal symptoms and BMD loss.To extend the time of chemical,the menopausal symptom and BMD ,estrogen decrease would further aggravate. There were moderate negative correlations between E2 and FSH levels,but BMD had high positive correlation with E2.The conjugated estrogens tablets 0.3mg qod as add-back therapy could relieve the symptoms of menopausal,but the level of serum E2 and BMD had no difference with using the chemical same time.2.The different time and methods had no relation with the rate of serum CA125 positive,FSH,VAS of the dysmenorrhea after stopping the chemical, recurrence rate and pregnancy rate.