摘要目的 评价经阴道直肠阴道隔子宫内膜异位症(RVE)病灶部分切除术联合药物长期维持治疗的效果.方法 分析2007年1月至2016年9月于北京协和医院门诊随访的、行经阴道RVE病灶部分切除术且术后药物维持治疗的102例患者的临床病理资料,分别采用视觉模拟评分(VAS)、女性性功能指数(FSFI)及健康调查简表(SF-36)评估患者术前及术后药物维持期间内异症相关疼痛、性功能及生命质量变化情况,并记录药物的不良反应和患者的总体满意度.结果 共纳入102例患者,其中48例(47.1%,48/102)术后放置左炔诺孕酮宫内缓释系统(LNG-IUS),54例(52.9%,54/102)术后口服屈螺酮炔雌醇(DRSP/EE).术后3个月与术前比较,痛经的VAS评分:LNG-IUS组分别为(2.5±0.8)、(7.6±1.3)分(P＜0.01),DRSP/EE组分别为(2.7±0.6)、(7.7±1.4)分(P＜0.01);FSFI总分:LNG-IUS组分别为(23.5±2.0)、(21.0±2.7)分(P＜0.01),DRSP/EE组分别为(23.4±1.2)、(21.5±2.2)分(P＜0.01);SF-36评分:两组患者躯体健康和精神健康的评分均较术前显著提高,LNG-IUS组分别为(74±13)、(56±19)分,(75±13)、(55±17)分,DRSP/EE组分别为(73±11)、(59±15)分,(75±9)、(54±14)分(P＜0.01).这些改善作用在术后6、12、24个月均得到稳定维持.术后用药期间,两组患者的总体满意度均在90%以上;点滴出血是LNG-IUS组患者最常见的不良反应,DRSP/EE组患者的不良反应相对较少.结论 经阴道RVE病灶部分切除术后联合药物长期维持治疗,对患者创伤小、手术并发症风险低,术后用药期间维持效果好,能提高生命质量,不良反应少,是1种安全有效的联合治疗长期管理模式.

abstractsObjective To evaluate different postoperative medications as maintenance treatment for rectovaginal endometriosis (RVE) patients after conservative surgery. Methods RVE patients who underwent transvaginal partial excision from January 2007 to September 2016 with regular outpatient follow-up were retrospectively screened. Those followed by a levonorgestrel-releasing intrauterine system (LNG-IUS) insertion or oral contraceptive drospirenone/ethinylestradiol (DRSP/EE) 3 mg/30μg administration were enrolled. Variations in endometriosis-related pain, sexual function and quality of life were measured by visual analogue scale (VAS), female sexual function index (FSFI) and short form 36-item health survey (SF-36) respectively. Results There were a total of 102 RVE patients with 48 (47.1%, 48/102) in LNG-IUS group and 54 (52.9%, 54/102) in DRSP/EE group included. A rapid and marked improvement was observed after 3 months postoperative medical treatment compared to preoperative in both groups (P＜0.01). In dysmenorrhea, for LNG-IUS group (2.5±0.8) versus (7.6±1.3;P＜0.01), for DRSP/EE group (2.7±0.6) versus (7.7 ± 1.4;P＜0.01);in FSFI, for LNG-IUS group (23.5 ± 2.0) versus (21.0 ± 2.7;P＜0.01), for DRSP/EE group (23.4 ± 1.2) versus (21.5 ± 2.2; P＜0.01); in SF-36, both groups had obvious improvements in physical component summary and mental component summary (P＜0.01), for LNG-IUS group (74±13) versus (56±19), (75±13) versus (55±17), for DRSP/EE group (73±11) versus (59±15), (75±9) versus (54±14). These effects were maintained stably and progressively during postoperative medication at 6-, 12-, 24-month follow up. Conclusion Transvaginal partial excision combined postoperative LNG-IUS or DRSP/EE treatment is a safe and viable technique to alleviate pain, improve sexual function and quality of life.