Analysis Of The Curative Effect Of Laparoscopic Combined With Drugs In Treatment Of Moderate And Severe Endometriosis

Objective: Through the retrospective analysis and follow-up patients who underwent Laparoscopic conservative surgery in the treatment of endometriosis in The Second Hospital of Hebei Medical University, this paper is to investigate the curative effect of Laparoscopic conservative surgery combined with commonly used drugs in treatment of moderate and severe endometriosis, and security of dienogest in the treatment of recurrent endometriosis-associated pelvic pain(EAPP).Methods: To reach the objective, this experiment made use of a method that analyzing retrospectively and following up 432 patients who had a Laparoscopic conservative surgery in the treatment of endometriosis in The Second Hospital of Hebei Medical University from January 2007 to January 2014. These patients were divided into 4 groups by using of different drugs postoperatively: A(Laparoscopic conservative surgery alone), B(Laparoscopic conservative surgery combined with Gn RH-a), C(Laparoscopic conservative surgery combined with IUS-LNG) and D(Laparoscopic conservative surgery combined with gestrinone). 15 recurrent EAPP patients use dienogest, 2 mg daily, 6-13 cycles. By doing all of the above, this paper is to analyze the remission of EAPP patients’ from the 4 groups above, the pregnancy rate and postoperative pregnancy period of patients with infertility, and the recurrence rate and postoperative recurrence period of EMs, and to assess the curative effect and security of dienogest in the treatment of endometriosis-associated pelvic pain.Results:1 There were no statistical differences in ages, BMI and r-AFS score among four groups[age: 31. 91y(25-38y), 31. 89y(26-37y), 31. 73y(25-37y), 30.73y(24-37y), P>0.05; BMI: 23.86kg/m2(22.37-25.35kg/m2), 23.49kg/m2Conclusions:1 Both Laparoscopic conservative surgery alone and Laparoscopic conservative surgery combined with drugs could improve EAPP and pregnancy rate.2 Laparoscopic conservative surgery combined with Gn RH-a or IUS-LNG could improve EAPP more significantly. Laparoscopic conservative surgery combined with Gn RH-a could also improve the pregnancy rate, but will not prolong postoperative pregnancy period.3 Comparing with Laparoscopic conservative surgery alone, to treat combined with drugs, the recurrence rate and postoperative recurrence period of EMs didn’t get lower.4 Dienogest is expected to be an ideal drug in treatment of recurrent EAPP.(20.39-26.59kg/m2), 22.86kg/m2(19.49-26.23kg/m2), 22.01kg/m2(19.86-24.16kg/m2), P>0.05; r-AFS score: 40.63(13.83-67.42), 51.43(25.60-77.26), 47.00(22.30-71.70), 41.18(19.47-62.89), P>0.05].2 There were statistical improvements of VAS scores of EAPP patients before and after the treatment in the four groups [A: 70 mm, 40 mm, P<0.01; B: 80 mm, 20 mm, P<0.01; C: 80 mm, 25 mm, P<0.01; D: 70 mm, 30 mm, P<0.01].3 Patients in group B and group C EAPP improved more obviously [A: 30 mm, B: 50 mm, C: 51.5mm, D: 40 mm, P<0.05; A vs B, P<0.05; A vs C, P<0.05; A vs D, P>0.05; B vs C, P>0.05; B vs D, P<0.05; C vs D, P<0.05].4 There were no statistical differences in recurrence rate of EMs among four groups [24.68%, 36.73%, 33.33%, 34.62%, P>0.05].5 There were no statistical differences in postoperative recurrence period of EMs among four groups[11.47 months(2.81-20.13 months), 12.82 months(4.40-21.24 months), 12.40 months(6.68-18.12 months), 11.28 months(4.46-18.10 months), P>0.05].6 There were 40 infertility patients in group A, 92 in B and 20 in D. The pregnancy rate improved significantly in group A, B and D, patients in group B improved more obviously[A: 40.00%, B: 65.21%, D: 50.00%, P>0.05; A vs B, P<0.05; A vs D, P>0.05; B vs D, P>0.05].7 There were no statistical differences in pregnancy period after surgery of infertility patients among three groups[11.63 months(6.17-17.10 months), 11.60 months(4.18-19.02 months), 9.20 months(4.33-14.07 months), P>0.05].8 The rates of adverse events in group B, C and D were significantly higher than group A’s [A: 1.30%(2/154), B: 39.80%(78/196), C: 33.33%(10/30), D: 46.15%(24/52), P<0.05], and there were no statistical differences between group B, C and D.9 There were significant improvements of VAS scores of EAPP recurrent patients before and after the treatment with dienogest. The rate of adverse events of patients who took dienogest was 66.67(10/15), and the incidence rate of irregular vaginal bleeding was 60%(9/15).