标题：地诺孕素与米非司酮在EMs保守术后长期维持治疗中的应用

      作者：尹小超 1，陈若兰 2，刘青 2    1.安康市中心医院妇科，陕西 安康 725000；2.西安市人民医院(西安市第四医院)妇产科，陕西 西安 710000

      卷次： 2023年34卷23期

      【摘要】 目的 比较地诺孕素(DNG)与米非司酮(MFP)在子宫内膜异位症(EMs)保守术后长期维持治疗中的应用效果。方法 选取2020年5月至2021年 1月在安康市中心医院行EMs腹腔镜保守手术的 102例患者作为研究对象，依据随机数表法分为DNG组和MFP组，每组51例。MFP组患者术后接受米非司酮治疗，DNG组患者术后接受地诺孕素治疗，两组患者均治疗 6个月。治疗后比较两组患者的临床疗效，于治疗前、治疗后 1周、2周及4周采用视觉模拟评分(VAS)评估患者的疼痛程度；于治疗前后采用EMs患者生存质量量表(EHP-5)评估患者的生存质量；治疗后随访18个月比较两组患者的复发及妊娠情况以及治疗期间的不良反应发生情况。结果 DNG组患者的临床治疗总有效率为94.12%，明显高于MFP组的80.39%，差异具有统计学意义(P<0.05)；两组患者治疗后1周、2周以及4周的VAS评分明显低于治疗前，且DNG组患者不同时间的VAS评分明显低于MFP组，差异均有统计学意义(P<0.05)；治疗后，两组患者的EHP-5评分明显低于治疗前，且DNG组患者EHP-5评分为(7.74±1.24)分，明显低于MFP组的(9.46±1.42)分，差异均有统计学意义(P<0.05)；术后为期18个月随访中，DNG组患者的复发率为23.53%，明显低于MFP组的 45.10%，妊娠率为 68.63%，明显高于MFP组的 43.14%，差异均具有统计学意义(P<0.05)；治疗期间DNG组患者的不良反应发生率为 13.73%，明显低于MFP组的 39.22%，差异具有统计学意义(P<0.05)。 结论 EMs患者保守术后采用DNG治疗较采用MFP疗效好，对患者的疼痛减轻效果更显著，同时可显著降低复发风险，提高患者妊娠率以及生存质量，且不良反应较少，安全性较高。
      【关键词】 子宫内膜异位症；地诺孕素；米非司酮；临床疗效；复发风险；生活质量；不良反应
      【中图分类号】 R711.74 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3411—04

Application of dienogest and mifepristone in long-term maintenance treatment after conservative surgery forendometriosis.
YIN Xiao-chao 1, CHEN Ruo-lan 2, LIU Qing 2. 1. Department of Gynecology, Ankang Central Hospital,Ankang 725000, Shaanxi, CHINA; 2. Department of Obstetrics and Gynecology, Xi'an People's Hospital (Xi'an FourthHospital), Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To compare the application effects of dienogest (DNG) and mifepristone (MFP) inlong-term maintenance treatment after conservative surgery for endometriosis (EMs). Methods A total of 102 patientswho underwent laparoscopic conservative surgery for EMs in Ankang Central Hospital from May 2020 to January 2021were selected as the research subjects. They were divided into DNG group and MFP group by random number tablemethod, with 51 patients in each group. After surgery, patients in MFP group were treated with MFP, and those in DNGgroup were treated with DNG. Both groups of patients were given 6 months of treatment. Clinical efficacy after treat-ment was compared between the two groups. Pain degrees before treatment and at 1 week, 2 weeks, and 4 weeks aftertreatment were evaluated with the Visual Analogue Scale (VAS). The patients were followed up for 18 months after treat-ment. The status of recurrence and pregnancy was compared between the two groups. The quality of life was evaluatedwith the Endometriosis Health Profile-5 (EHP-5) before and after treatment. The incidence rates of adverse reactionsthat occurred during treatment were calculated. Results The total effective rate of clinical treatment in the DNGgroup was 94.12%, significantly higher than 80.39% in the MFP group (P<0.05). The VAS scores of the two groups ofpatients at 1 week, 2 weeks, and 4 weeks after treatment were significantly lower than those before treatment, and the VASscores of the DNG group at different times were significantly lower than those of the MFP group, with statistically signifi-cant differences (P<0.05). After treatment, the EHP-5 scores of the two groups were significantly lower than those beforetreatment, and the EHP-5 scores were significantly lower in the DNG group than in the MFP group [(7.74±1.24) points vs(9.46±1.42) points], with statistically significant differences (P<0.05). During the 18 month follow-up period after sur-gery, the recurrence rate of patients in the DNG group was 23.53%, significantly lower than 45.10% in the MFP group,and the pregnancy rate was 68.63%, significantly higher than 43.14% in the MFP group, with statistically significant dif-ferences (P<0.05). The incidence of adverse reactions in the DNG group during treatment was 13.73%, significantly low-er than 39.22% in the MFP group (P<0.05). Conclusion DNG is more effective than MFP in long-term maintenancetreatment after conservative surgery for EMs. The former can better relieve pain, significantly reduce recurrence risk,and improve the pregnancy rate and quality of life, with fewer adverse reactions and higher safety.
      【Key words】 Endometriosis; Dienogest; Mifepristone; Clinical effect; Recurrence risk; Quality of life; Adversereaction