注射用醋酸亮丙瑞林微球联合优思明治疗子宫内膜异位症顽固性疼痛【摘要】目的探?注射用醋酸亮丙瑞林微球联合屈螺酮炔雌醇片（优思明）治疗子宫内膜异位症顽固性疼痛的临床疗效。方法60例子宫内膜异位症顽固性疼痛患者，采用随机双盲分为治疗组和对照组，各30例。对照组采用注射用醋酸亮丙瑞林微球[促性腺激素释放激素激动剂（GnRH-a）]治疗，治疗组在对照组基础上序贯加用优思明治疗。比较两组治疗效果、复发情况、疼痛情况及不良反应发生情况。结果对照组缓解率为73.3%（22/30），治疗组缓解率为96.7%（29/30），治疗组缓解率明显高于对照组，差异具有统计学意义（P<0.05）。对照组随访第1年复发3例（10.0%），治疗组无复发患者；对照组随访第2年复发7例（23.3%），治疗组复发2例（6.7%）；两组累积复发率比较差异有统计学意义（P<0.05）。治疗后治疗组视觉模拟评分法（VAS）评分为（1.2±0.6）分，低于对照组的（3.5±1.2）分，差异有统计学意义（P<0.05）。两组均未出现围绝经期症状。两组体重增加、肝功能异常发生率比较差异均无统计学意义（P>0.05）；治疗组不规则阴道出血发生率3.3%低于对照组20.0%，差异有统计学意义（P<0.05）。结论GnRH-a联合优思明用于治疗子宫内膜异位症顽固性疼痛具有明显疗效，可有效降低复发率、延长复发时限，比较安全、可靠，值得临床应用。【关键词】子宫内膜异位症；顽固性疼痛；注射用醋酸亮丙瑞林微球；屈螺酮炔雌醇片DOI：10.14163/jki.11-5547/r.2018.01.003【Abstract】ObjectiveTodiscusstheclinicalefficacyofleuprorelinacetatemicrospheresforinjectioncombinedwithdrospirenoneandethinylestradioltablets（yasmin）inthetreatmentofendometriosiswithintractablepain.MethodsAtotalof60endometriosispatientswithintractablepainweredividedbyrandomdouble-blindmethodintotreatmentgroupandcontrolgroup，with30casesineachgroup.Thecontrolgroupwastreatedwithleuprorelinacetatemicrospheresforinjection[gonadotropinreleasinghormoneagonist（GnRH-a）]，andthetreatmentgroupwastreatedwithsequentialtreatmentofyasminonthebasisofthecontrolgroupparisonweremadeontreatmenteffect，recurrentstatus，painstatusandoccurrenceofadversereactionsbetweentwogroups.ResultsThecontrolgrouphadremissionrateas73.3%（22/30），whilethetreatmentgrouphadremissionrateas96.7%（29/30）.Thetreatmentgrouphadobviouslyhigherremissionratethanthecontrolgroup，andthedifferencewasstatisticallysignificant（P<0.05）.Thecontrolgrouphad3recurrentcases（10.0%）during1-yearfollow-up，whilethetreatmentgrouphadnorecurrentcases.Thecontrolgrouphad7recurrentcases（23.3%）during2-yearfollow-up，whilethetreatmentgrouphad2recurrentcases（6.7%）.Bothgroupshadstatisticallysignificantdifferenceincumulativerecurrencerate（P<0.05）.Aftertreatment，thetreatmentgrouphadlowervisualanaloguescale（VAS）scoreas（1.2±0.6）pointsthan（3.5±1.2）pointsinthecontrolgroup，andthedifferencewasstatisticallysignificant（P<0.05）.Bothgroupshadnoperimenopausalsymptoms.Bothgroupshadnostatisticallysignificantdifferenceinincidenceofweightgainingandabnormalliverfunction（P>0.05）.Thetreatmentgrouphadlowerincidenceofirregularvaginalbleedingas3.3%than20.0%inthecontrolgroup，andthedifferencewasstatisticallysignificant（P<0.05）.ConclusionCombinationofGnRH-aandyasminshowsobviousefficacyintreatingendometriosiswithintractablepain，andcaneffectivelyreducerecurrencerateandprolongrecurrencetime.Itissaferandmorereliable，andworthyofclinicalapplication.【Keywords】Endometriosis；Intractablepain；Leuprorelinacetatemicrospheresforinjection；Drospirenoneandethinylestradioltablets子宫内膜异位症多见于年轻患者，尤其是育龄期妇女发生率较高，可达10%～15%，近年来发病...