目的：探讨促性腺激素释放激素激动剂（ GnRH-a）联合去氧孕烯炔雌醇（妈富隆）治疗重度子宫内膜异位症（ EM）的临床疗效。方法选取2009年1月-2012年5月我院收治的80例重度EM患者，均行腹腔镜保守性手术。将患者随机分为两组：对照组38例，术后单纯给予GnRH-a治疗；观察组42例，术后给予GnRH-a联合妈富隆治疗。随访观察1年，比较两组患者术前和术后1年内分泌激素〔卵泡刺激素（ FSH）、黄体生成素（ LH）、雌二醇（ E2）〕水平、围绝经期症状的严重程度（ Kupperman评分）及患者围绝经期症状的主观感受。结果术前两组患者FSH、LH、E2水平间无差异（P>0.05）；而术后均较本组术前下降（P<0.05），但术后两组患者上述指标间无差异（P>0.05）。术前两组患者潮热出汗评分，外阴、阴道不适评分，关节痛评分，Kupperman总分间无差异（P>0.05）；术后观察组外阴、阴道不适评分及Kupperman总分均低于对照组〔（1.1±1.0）分与（2.0±1.5）分，（9.0±1.2）分与（10.5±1.3）分，P<0.05〕，而两组潮热出汗、关节痛评分间无差异（ P>0.05）。术前两组患者痛经、慢性盆腔痛、性交痛评分及主观感受总分间无差异（ P>0.05）；术后观察组患者慢性盆腔痛评分、主观感受总分均低于对照组〔（0.20±0.32）分与（0.40±0.53）分，（2.53±1.21）分与（3.47±1.31）分，P<0.05〕，而两组痛经、性交痛评分间无差异（ P≥0.05）。结论妈富隆可减轻重度EM患者GnRH-a治疗后引起的低雌激素症状，并能有效缓解EM的疼痛症状。%Objective Toinvestigatetheclinicalefficacyofgonadotropin-releasinghormoneagonist(GnRH-a) combinedwithdesogestrel-ethinylestradiolfortreatingsevereendometriosis.Methods Atotalof80patientswithsevereendo-metriosis who were admitted to our hospital and were treated by laparoscopic conservative operation from January 2009 to May 2012,were selected as study subjects. The patients were randomly divided into two groups:control group(38 cases)received GnRH-a treatment alone after operation,while observation group(42 patients)were given the treatment of GnRH-a combined Marvelon after operation. The patients were followed up for 1 year,levels of the endocrine hormones( FSH,LH,E2 ),severity of perimenopausal period syndrome( Kupperman score)and patients'subjective feelings for perimenopausal period syndrome were comparedbetweentwogroupsofpatientsbeforeoperationandin1yearafteroperation.Results Therewasnosignificantdiffer-ence in levels of FSH,LH and E2 between two groups of patients before operation(P>0. 05). For both groups,levels of FSH, LH and E2 after operation were significantly lower than those before operation(P<0. 05),there was no significant difference in levels of FSH,LH and E2 between two groups of patients in 1 year after surgery(P>0. 05). There was no significant difference in hot flushes and sweating score,vulvovaginal discomfort score,joint pain score and Kupperman score between two groups of pa-tients before operation(P>0. 05). The vulvovaginal discomfort score and Kupperman score in observation group were significant lower than those in control group〔(1. 1±1. 0)vs. (2. 0±1. 5),(9. 0±1. 2) vs. (10. 5±1. 3),P<0. 05〕in 1 year after surgery. There was no significant difference in hot flushes and sweating score and joint pain score between two groups in 1 year af-ter surgery(P >0. 05). There was no significant difference in dysmenorrhea score,chronic pelvic pain score,dyspareuniascore and subjective feelings total score between two groups of patients before operation ( P >0. 05 ) . The chronic pelvic pain score and subjective feelings total score in observation group were significant lower than those in control group in 1 year after sur-gery〔(0. 20±0. 32) vs. (0. 40±0. 53),(2. 53±1. 21) vs. (3. 47±1. 31),P<0. 05〕. There was no significant differ-enceindysmenorrheascoreanddyspareuniascorebetweentwogroupsin1yearaftersurgery(P≥0.05).℅onclusion Marvel-on can relieve the low level estrogen-related symptoms caused by GnRH-a treatment among patients with severe endometriosis, and can relieve pain symptom caused by endometriosis.
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