卵巢子宫内膜异位囊肿术后药物治疗进展：GnRH-a、地诺孕素及LNG-IUS的应用
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i1.18542
Abstract
卵巢子宫内膜异位囊肿(OE)术后高复发率是临床关键挑战,术后药物辅助治疗以抑制残留病灶、缓解疼痛、降低复发为核心目标。本文系统综述 GnRH-a(如亮丙瑞林)、地诺孕素(DNG)、LNG-IUS 的单药疗效、安全性、疗程争议及联合策略。研究显示,GnRH-a 短期治疗(3～6个月)快速抑灶但需警惕骨丢失；DNG长期治疗(≥12个月)疗效与骨密度安全性均衡；LNG-IUS局部释药降复发,适用于无生育需求者。联合方案(如GnRH-a序贯DNG或LNG-IUS)在提升妊娠率、延缓复发上具协同效应,最佳疗程及安全性仍需大样本研究验证,本综述为临床个体化治疗提供循证依据。
Keywords
卵巢子宫内膜异位囊肿；术后治疗；促性腺激素释放激素激动剂；地诺孕素；左炔诺孕酮宫内缓释系统
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[3] 张苗,应超,李明珠.注射用醋酸亮丙瑞林微球对子宫内膜异位症腹腔镜术后患者的临床价值[J].中国妇幼保健,2021,36(12):2705-2707.
[4] 何春妮,宋岩峰.长效促性腺激素释放激素激动剂治疗子宫内膜异位症的疗效观察[J].世界医学杂志,2001,5(5):47-48.
[5] 王久兰,何伟,周夏伶,等.地诺孕素、亮丙瑞林辅助治疗卵巢子宫内膜异位囊肿的临床效果比较[J].中国妇产科临床杂志,2022,23(03):275-277.
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[8] Römer T.Long-term treatment of endometriosis with dienogest:retrospective analysis of efficacy and safety in clinical practice[J].Archives of gynecology and obstetrics, 2018,298:747-753.
[9] Seo J W, Lee D Y, Yoon B K, et al. Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density[J].European Journal of Obstetrics & Gynecology and Reproductive Biology,2017,212:9-12.
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[11] Techatraisak K, Hestiantoro A, Soon R, et al. Impact of long-term dienogest therapy on quality of life in Asian women with endometriosis: the prospective non-intervention al study ENVISIOeN[J]. Reproductive Sciences,2022,29(4):1157-1169.
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[14] 周静,戴星,谢彤.卵巢子宫内膜异位囊肿剥除术后放置左炔诺孕酮宫内节育器的临床观察[J].中国妇幼保健,2010,25(5):681-683.
[15] 林素霞,何华.卵巢子宫内膜异位囊肿剥除术后放置曼月乐的观察[J].中国妇幼健康研究,2011,22(1):11.
[16] VercelliniP,Frontino G, De Giorgi O, et al. Comparison of a levonorgestrel-releasing intrauterine device versus exp ectant management after conservative surgery for symptoma tic endometriosis:a pilot study[J].Fertility and sterility,2003,80(2):305-309.
[17] 蔡克影,李芹,索虹蔚,等.左炔诺孕酮宫内缓释系统治疗腹腔镜术后复发性卵巢子宫内膜异位症患者的临床研究[J].中国内镜杂志,2013,19(03):288-290.
[18] 李改玲,史惠蓉,任芳.LNG-IUS治疗子宫内膜异位症术后的临床观察[J].国际妇产科学杂志,2011,38(6):575-577+587.
[19] Petta C A, Ferriani R A, Abrao M S, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine syst em and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis[J].Human Reproduct ion,2005,20(7):1993-1998.
[20] Kitawaki J,Kusuki I,Yamanaka K,et al.Maintenance ther apy with dienogest following gonadotropin-releasing hormone agonist treatment for endometriosis-associated pelvic pain [J].European Journal of Obstetrics & Gynecology and Reproduc tive Biology,2011,157(2):212-216.
[21] 张晖.促性腺激素释放激素激动剂联合左炔诺孕酮宫内缓释系统对重度子宫内膜异位症患者生育功能的影响[J].中国妇幼保健,2022,37(22):4222-4225.
[22] 郭立文,高琛,陈锦果,等.地诺孕素联合左炔诺孕酮宫内节育系统治疗子宫内膜异位症患者的临床研究[J].中国临床药理学杂志,2024,40(04):505-509.
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