Clinical Ananlysis Of Laparoscopic Operation Followed By Different Drugs On Treatment Of Endometriosis

Objective: Endometriosis (EMS) is a gynecological diseases which can bleed periodically when the active endometrial tissue lies outside the uterine body. EMS is an estrogen-dependent disease, and could always be seen in women of reproductive age. Although EMS is a benign disease, it presents as malignant behaviors of metastasis, planting and recurrence. It can form a wide range of severe adhesion in the pelvis and is the main cause of chronic pelvic pain and infertility. The preferred treatment is surgery. If not controlled with drugs after the operation, the relapse rate of endometriosis is higher. Surgery followed by drug therapy will enable the remnants of small lesions or a number of potential lesions which is difficult to see by the naked eyes to be restrained, atrophied, degenerated in order to prevent and delay the relapse. The purpose of this study is to evaluate our hospital for the efficacy and safety of the consolidation of the joint drug treatment after the laparoscopic conservative surgery of endometriosis and make a guide of our hospital to establish the standardized treatment of endometriosis.Methods: Collected endometriosis patients (except for adenomyosis) confirmed by pathology that underwent laparoscopic conservative surgery in the Fourth Hospital of Hebei Medical University were 173 cases, 149 can follow-up, and the rate is 86.13%, from January 2004 to December 2007. According to the American Fertility Society stages law in 1985 (R-AFS), all the cases were divided into different stages. In accordance with different drugs, all the cases that received laparoscopic conservative surgeries were divided into 3 groups: A group (non-drug treatment group), B group (Gestrinone group) and C group (Diphereline group). An Excel database was built with clinical follow-up survey. The data were analyzed by statistical software SPSS 11.5, with measurement data using analysis of variance and compare of the rate usingχ2 test.Results:1 The remission rate: The symptom remission rate ofⅠ~Ⅱperiod patients at A group was 64.52%, B group was 75.00% and C group was 92.31%. There has no statistical difference between the three groups (χ2A-B=6.21, P=0.431;χ2A-C correction=2.30, P=0.129, Fisher exact probability was used for comparision between B and C, P=0.364, P>0.05). The symptom remission rate ofⅢ~Ⅳperiod patients at A group was 22.22%, B group was 51.61% and C group was 85.19%. B, C groups was higher than A group (χ2A-B=5.30, P=0.021;χ2A-C=21.53, P=0.000, P<0.05), and has statistical significance; C group was higher than B group (χ2B-C=7.38, P=0.007, P<0.05) and also has statistical significance.2 The relapse rate: After surgery ofⅠ~Ⅱperiod patients, the recurrence rate of A group was 35.48%, B group was 25.00% and C group was 7.69%, and has no statistical difference between the three groups (χ2A-B=6.21, P=0.431;χ2A-C correction=2.30, P=0.129; Fisher exact probability was used for comparision between B and C, P=0.364, P>0.05). The recurrence rate ofⅢ~Ⅳperiod patients at A group was 66.67%, B group was 38.71% and C group was 7.4%, A group was higher than B and C groups (χ2A-B=4.52, P=0.034;χ2A-C=20.33, P=0.000, P<0.05), and has statistical significance; B group was higher than C group (χ2B-C=7.72, P=0.005, P<0.05), and also has statistical significance.3 Pregnant and delivery rate: Of the patients, 58 cases suffered the complication of infertility,in which 32 gave birth to babies after followed up with at least 2 years. A group has 7 cases of dilivery in 19 patients and the rate was 36.84%. In B group the number was 7 in 16 and the rate was 43.75%, and in C group, it was 18 in 23 and 78.26%. There was no statistical difference between A and B groups (χ2A-B=0.173, P=0.678, P>0.05); while there were statistical difference between A&C groups and B&C groups (χ2A-C=7.41, P=0.006;χ2B-C=4.88, P=0.027, P<0.05). Diphereline group is higher than both Gestrinone group and non-drug treatment group. There were 32 cases gave birth to babies after surgery. The number of the pregnancy occurring in 12 months accounted for 78.13% while the number of the pregnancy occurring after 12 months accounted for 21.87%.4 Drug adverse reactions: In Gestrinone group, 30 cases in total had adverse reactions such as increasing transaminasein, irregular vaginal bleeding, weight gain and acne, etc .The adverse reactions incidence rate was 58.82%. In Diphereline group, there were 11 cases in total with low-dose estrogen symptoms such as hot flashes, restlessness, etc. The adverse reaction rate was 27.5%. The adverse reactions in Diphereline group is lower than Gestrinone group (χ2=8.89, P=0.003, P <0.05). The adverse reactions in gestrinone group were liver dysfunction, weight gain, acne, whereas low estrogen such as hot flashes etc happened in Diphereline group.Conclusions:1 For the patients of endometriosis at stageⅠ~Ⅱperiod by laparoscopic conservative surgery with removing the lesions radically that adjuvant treatment with drugs may not use; and for patients at stageⅢ~Ⅳperiod use Diphereline or Gestrinone can both enhance the symptom remission rate and reduce recurrence rate, but the effectiveness of Diphereline is better than Gestrinone.2 For ovarian endometriosis patients which are at the period of child -bearing age after conservative treatment with laparoscopic, using Diphereline can significantly improve the pregnancy rate, while using Gestrinone can not significantly improve the pregnancy rate.3 The highest pregnancy rate occurred within 6 months after the laparoscopic surgery or after stopping drug therapy following operation. It is suggested that EMS patients should be pregnant within 6 months after laparoscopic surgery or after stopping drug therapy following operation.4 The side reactions of Gestrinone is mainly in the effects of liver dysfunction, weight gain, acne. The side reaction of Diphereline is mainly in low-estrogen symptoms.