| Objective:To evaluate the efficacy and safety of DNG in the postoperative maintenance treatment of ovarian endometriosis cysts(OEMC)by comparing the effects and adverse reactions of gonadotropin releasing hormone agonist(GnRH-a)and dinogestrin(DNG)as follow-up adjuvant treatment after laparoscopic conservative treatment,so as to provide reference for postoperative drug adjuvant treatment.Methods:A retrospective cohort study was conducted to collect 212 cases who underwent laparoscopic OEMC exfoliation in Northwest women’s and children’s Hospital from January1,2018 to January 1,2021 and were confirmed by postoperative pathology according to the nanodischarge criteria.According to the different follow-up treatment schemes after operation,they were divided into three groups.Group A: 67 cases without medication after operation;Group B: 91 cases were treated with GnRH-a after operation;Group C: 54 cases were treated with DNG after operation.The body mass index,age,number of pregnancies,number of births,course of disease,intraoperative conditions(such as maximum diameter of cyst and amount of intraoperative bleeding),preoperative VAS score,AMH level,tumor markers(AFP,CA125,CA153,CA199 and HE4)level of the three groups were compared.The levels of tumor markers,pregnancy,recurrence,total effective rate and adverse reactions of the drug group were followed up 6 months after operation.Result:1.The body mass index(BMI),age,number of pregnancies,number of births,number of previous hysteroscopic and laparoscopic operations,course of disease,level of tumor markers,intraoperative condition,preoperative visual analogue score(VAS),level of anti Mullerian hormone(AMH)and other general conditions of the three groups were not statistically different(P > 0.05).The data of the three groups were comparable;2.The VAS scores of the three groups at 6 and 12 months after laparoscopic conservative treatment were significantly lower than those before operation(P < 0.05).The VAS scores of group B and group C at 6 and 12 months after operation were lower than those of group A(P < 0.05),but there was no significant difference between group B and group C at 6 and 12 months after operation(P > 0.05);3.The levels of CA125,CA199 and HE4 in group B and group C were significantly lower than those in group A(P > 0.05),and there was no significant difference between group B and group C(P > 0.05);4.The levels of AMH in group B and group C were significantly higher than those in group A(P < 0.05),but there was no significant difference between group B and group C(P > 0.05);5.48 patients in group A had the intention of pregnancy,17 patients were pregnant 12 months after operation,and the pregnancy rate was 35.42%;46 patients in group B had the intention of pregnancy,24 patients were pregnant 12 months after operation,and the pregnancy rate was 52.17%;In group C,32 people had the intention of pregnancy,18 people were pregnant 12 months after operation,and the pregnancy rate was 56.25%;The12-month pregnancy rate in group B and group C was higher than that in group A,but there was no significant difference in the pregnancy rate among the three groups(P > 0.05).Compared with the two groups,it was found that there was no significant difference in the12-month pregnancy rate between group B and group C(P > 0.017);6.The cumulative recurrence rate in group A 12 months after operation was 10.45%(7 /67);The cumulative recurrence rate in group B was 2.20%(2 / 91);The cumulative recurrence rate in group C was 1.85%(1 / 54).12 months after operation,the cumulative recurrence rate of group B and group C was lower than that of group A(P < 0.017),but there was no significant difference between group B and group C(P > 0.017);7.12 months after operation,the total effective rate in group A was 89.55%(60 / 67);The total effective rate of group B was 97.80%(89 / 91);The total effective rate of group C was 98.15%(53 / 54).The total effective rate of group B and group C was higher than that of group A(P < 0.017),but there was no significant difference between group B and group C(P > 0.017);8.The total incidence of adverse reactions in group B was 68.14%(62 / 91);The total incidence of adverse reactions in group C was 38.89%(21 / 54);The total incidence of adverse reactions in group B was significantly higher than that in group C(P < 0.05).9.Adjuvant medication after operation of OEMC is a protective factor for prevention recurrence(OR<1,P<0.05).Conclusion:1.Laparoscopic OEMC exfoliation can effectively remove the focus and improve the symptoms of patients,but the postoperative recurrence rate is high and needs follow-up adjuvant treatment.2.Adjuvant medication after operation of OEMC is a protective factor for prevention recurrence.3.Both GnRH-a and DNG can effectively reduce the levels of CA125,CA199,HE4,VAS score and recurrence rate after OEMC,and improve the total effective rate.The therapeutic effects of GnRH-a and DNG are equivalent,and the incidence of adverse reactions of DNG is lower than that of GnRH-a.4.The curative effect of DNG is comparable to that of GnRH-a and can be used as an excellent choice for drug adjuvant treatment after OEMC stripping. |
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