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目的:探讨子宫内膜异位症(EMs)手术后补充治疗和预防复发用药的个体化治疗问题。方法:回顾性分析腹腔镜手术后的EMs患者应用GnRHa引起的不良反应、随访月经恢复时间、恢复月经后痛经改善等情况。结果:共收集病例资料80例,应用GnRHa3-6个月。80例中30例因不良反应反向添加雌、孕激素类药物,不良反应主要表现为阴道出血(52例,65.0%)、潮热(62例,77.5%)、出汗(60例,75.0%)、阴道干燥(42例,52.5%)、性欲下降(32例,40.0%)、情绪改变(17例,21.2%)、骨痛(16例,20%)、乏力(7例,8.7%)、停用GnRHa 1-3个月后月经恢复;月经恢复后痛经缓解率为73.6%(35/59)。结论:①因应用GnRHa引起的雌激素低落导致的不良反应存在明显的个体差异,常规反向添加剂量并不能缓解所有患者的症状。②不良反应发生情况与疗效相关,建议对患者进行个体化治疗,对于阴道出血持续时间长者建议增加GnRHa剂量,对于不良反应显著者可在第2个月时减低GnRHa剂量。
Objective: To explore the individualized treatment of supplementary therapy and prevention of recurrence after endometriosis (EMs) surgery. Methods: The retrospective analysis of adverse reactions caused by GnRHa after laparoscopic surgery in patients with EMs, follow-up period of menstruation recovery, to restore menstrual dysmenorrhea and so on. Results: A total of 80 cases were collected and 3 to 6 months of GnRHa application. Among 80 cases, 30 cases were adversely added with estrogen and progesterone drugs. The main adverse reactions were vaginal bleeding (52 cases, 65.0%), hot flashes (62 cases, 77.5%) and sweating (42 cases, 52.5%), decreased libido (32 cases, 40.0%), mood changes (17 cases, 21.2%), bone pain (16 cases, 20% ), Menstruation was restored after GnRHa was stopped for 1-3 months, and the rate of dysmenorrhea was 73.6% (35/59) after menstruation recovered. Conclusions: ① There are obvious individual differences in the side effects caused by estrogen lowering caused by GnRHa administration. Conventional reverse dosage does not alleviate the symptoms of all patients. ② adverse reactions and the efficacy of the relevant, it is recommended that patients with individualized treatment for the elderly with longer duration of vaginal bleeding is recommended to increase the dose of GnRHa, for those with significant adverse reactions in the first two months to reduce the dose of GnRHa.