目的 研究曲普瑞林联合左炔诺孕酮宫内节育系统治疗子宫内膜异位症的疗效以及对其性激素水平及复发风险的影响。方法 选自深圳市龙岗区妇幼保健院于2018年9月—2021年9月收治的子宫内膜异位症行腹腔镜手术患者68例，以随机数字表法将患者分为对照组和治疗组，每组各34例。对照组以左炔诺孕酮宫内节育系统进行治疗，于术后第1次月经周期3～5d时放置左炔诺孕酮宫内节育系统，并进行常规抗感染治疗，月经后进行B超复查确定左炔诺孕酮宫内节育系统是否发生位移。治疗组患者则在此基础上皮下注射醋酸曲普瑞林注射液，3.75mg/次，1次/月。治疗组治疗6个月，期间对照组持续随访。观察两组患者临床疗效，比较治疗前后两组患者排卵恢复正常时间，月经恢复正常时间，痛经评分，临床量表评分，血清血管内皮细胞生长因子（VEGF）、基质金属蛋白酶-9/组织金属蛋白酶抑制物-1（MMP-9/TIMP-1）、可溶性细胞黏附因子（sICAM-1）、卵泡刺激素（FSH）、促黄体生成素（LH）和雌二醇（E₂）水平，及复发率和不良反应。结果 治疗后，治疗组临床有效率明显高于对照组（P＜0.05），治疗组排卵恢复正常时间、月经恢复正常时间与对照组相比明显缩短（P＜0.05）。与治疗前比，治疗后两组痛经评分及视觉模拟评分法（VAS）评分及血清VEGF、MMP-9/TIMP-1、sICAM-1、FSH、LH水平均明显降低（P＜0.05），且治疗组明显低于对照组（P＜0.05）。治疗后，两组生理健康、心理健康评分水平均明显升高（P＜0.05），且治疗组高于对照组（P＜0.05）。治疗组治疗期间不良反应总发生率、术后6个月复发率均明显低于对照组（P＜0.05）。结论 曲普瑞林联合左炔诺孕酮宫内节育系统治疗子宫内膜异位症能改善机体性激素水平，降低各项血管侵袭指标水平，促进月经及排卵恢复正常周期，减轻疼痛，减少不良反应及复发风险，提高生活质量。

Objective To study the effect of triptorelin combined with Levonorgestrel Intrauterine System (LNG-IUS) on sex hormone levels and risk of recurrence in patients with endometriosis after operation. Methods Patients (68 cases) with endometriosis undergoing laparoscopic surgery in Shenzhen Longgang District Maternal and Child Healthcare Hospital from September 2018 to September 2021 were randomly divided into control and treatment group, and each group had 34 cases. Patients in the control group were administered with LNG-IUS at the 3rd to 5th day of the first menstrual cycle after surgery, and administered with routine anti infection treatment, B-ultrasonic reexamination was performed after menstruation to determine whether LNG-IUS was displaced or not. Patients in the treatment group subcutaneous injection administered with Triptorelin Acetate Injection on the basis of the control group, 3.75 mg/time, once monthly. The treatment group was treated for 6 months, during which the control group was followed up continuously. After treatment, the clinical evaluation was evaluated, the ovulation recovery time, menstrual recovery time and dysmenorrhea score, the clinical scale scores, serum VEGF, MMP-9/TIMP-1, sICAM-1, FSH, LH and E₂ levels, the recurrence rates and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was significantly higher than that of the control group (P<0.05), the time for ovulation and menstruation to return to normal in the treatment group was significantly shorter than that in the control group (P<0.05). After treatment, the dysmenorrhea score, VAS score, serum VEGF, MMP-9/TIMP-1, sICAM-1, FSH and LH levels in two groups were significantly lower than those before treatment (P<0.05), and which in the treatment group was significantly lower than the those in the control group (P<0.05). After treatment, the scores of physical health and mental health in two groups were significantly higher (P<0.05), and the scores in the treatment group were higher than those in the control group (P<0.05). The total incidence of adverse reactions and the recurrence rate 6 months after operation in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Triptorelin combined with LNG-IUS can improve the level of sex hormone, reduce the level of vascular invasion index, promote menstruation and ovulation to return to normal cycle, reduce pain, reduce the risk of adverse reactions and recurrence, and improve the quality of life in patients with endometriosis after operation.

R984

深圳市福田区卫生公益性科研项目（FTWS2016066）