单孔腹腔镜联合促性腺激素释放激素激动剂治疗深部浸润型子宫内膜异位症的临床疗效及对预后的影响

Clinical efficacy of single-port laparoscopy combined with GnRH agonist in the treatment of deep infiltrating endometriosis and its influence on prognosis

摘要:

目的 探讨单孔腹腔镜联合促性腺激素释放激素激动剂（GnRH agonist）治疗深部浸润型子宫内膜异位症的临床疗效及其对血清circATRNL1水平的影响，并分析其对预后的预测价值。方法 选取2021年6月－2023年10月在该院就诊的深部浸润型子宫内膜异位症患者220例，根据手术方法不同，将患者分为实验组（n = 110）和对照组（n = 110）。实验组接受单孔腹腔镜手术联合GnRH agonist治疗，对照组接受单孔腹腔镜手术治疗。比较两组患者治疗前后的circATRNL1水平变化情况，评估两组患者的近期疗效和远期预后。采用Spearman分析，探讨治疗后circATRNL1表达水平与远期预后的关系。根据随访期间是否复发，将患者进一步分为复发组（n = 42）和未复发组（n = 178），比较两组患者治疗前后circATRNL1表达水平，采用受试者操作特征曲线（ROC curve），分析治疗后circATRNL1表达水平对患者远期复发的预测价值。结果 治疗后，实验组的血清circATRNL1表达水平明显低于对照组，差异有统计学意义（P < 0.05）。实验组术后疼痛VAS评分明显低于对照组，生存质量明显优于对照组，复发率明显低于对照组，差异均有统计学意义（P < 0.05），实验组受孕率高于对照组，术后痛经率低于对照组，但差异无统计学意义（P > 0.05）。Spearman相关分析显示，治疗后circATRNL1表达水平与复发呈正相关（r = 0.290，P < 0.05），与受孕率无明显相关性（r = 0.060，P > 0.05）。治疗后，复发组血清circATRNL1表达水平明显高于未复发组，差异有统计学意义（P < 0.05）。ROC curve分析显示，治疗后血清circATRNL1水平预测术后远期复发的曲线下面积（AUC）为0.746，敏感度为64.29%，特异度为82.02%，具有较高的预测价值。结论 单孔腹腔镜联合GnRH agonist治疗方案，能够减轻疼痛，改善生存质量，降低复发率，还能降低血清circATRNL1水平。血清circATRNL1表达水平对术后远期复发，具有较好的预测价值。

Abstract:

Objective To explore the clinical efficacy of single-port laparoscopy combined with gonado-tropin-releasing hormone agonist (GnRH agonist) in the treatment of deep infiltrating endometriosis and its influence on serum circATRNL1 levels, and analyze its predictive value for patient prognosis.Methods 220 patients with deep infiltrating endometriosis from June 2021 to October 2023 were enrolled as study subjects and divided into an experimental group (n = 110) and a control group (n = 110) according to different surgical methods. The experimental group received single-port laparoscopy surgery combined with GnRH agonist treatment, while the control group only received single-port laparoscopy surgery. The changes in circATRNL1 expression level before and after treatment between the two groups were compared, the short-term efficacy and long-term prognosis of the two groups were evaluated. Spearman correlation analysis was conducted to explore the relationship between circATRNL1 expression levels after treatment and long-term prognosis. All patients were regrouped based on whether they relapsed during follow-up into a relapse group (n = 42) and a non-relapse group (n = 178). The circATRNL1 levels before and after treatment were compared between the two groups, and the predictive value of circATRNL1 expression levels after treatment for long-term relapse after treatment in patients with endometriosis was analyzed using a receiver operating characteristic curve (ROC curve).Results After treatment, the serum circATRNL1 levels in the experimental group was significantly lower than that in the control group, the difference was statistically significant (P < 0.05). The postoperative pain VAS score of the experimental group was significantly lower than that of the control group, and the quality of life was significantly better than that of the control group, the recurrence rate was significantly lower than that of the control group, and the differences were statistically significant (P < 0.05). The pregnancy rate of the experimental group was higher than that of the control group, and the postoperative dysmenorrhea rate was lower than that of the control group, but the differences were not statistically significant (P > 0.05). Spearman correlation analysis showed that circATRNL1 expression levels after treatment was positively correlated with relapse among long-term prognosis indicators (r = 0.290, P < 0.05), but had no significant correlation with pregnancy rate (r = 0.060, P > 0.05). Compared to patients in the non-relapse group, the relapse group had significantly higher serum circATRNL1 expression levels after treatment, the difference was statistically significant (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) for serum circATRNL1 expression levels in predicting long-term postoperative relapse in patients with endometriosis after treatment was 0.746, with a sensitivity of 64.29% and a specificity of 82.02%, indicating good predictive value.Conclusion The treatment regimen combining single-port laparoscopy with GnRH agonist can significantly reduce patients’ pain levels, improve their quality of life, and decrease the recurrence rate. Furthermore, this combined therapy also notably decreases serum circATRNL1 levels. The serum circATRNL1 expression levels have good predictive value for the long-term recurrence of deep-infiltrating endometriosis patients post-surgery.