目的探讨不同药物治疗方案治疗重度子宫内膜异位症(endometriosis,EMs)的疗效以及对患者生育能力的影响。方法选取2014年9月-2016年7月陈星海医院期间收治的109例重度EMs患者为研究对象,所有患者均自愿接受手术及术后药物治疗。患者根据自愿选择不同的药物治疗方案进行分组,A组35例,采用孕三烯酮方案治疗,B组41例,采用米非司酮方案治疗,C组33例,采用促性腺激素释放激素激动剂(GnRHa)治疗。比较三组疗效、血清CA125水平、复发及并发症情况。检测三组术前术后黄体生成激素(LH)、卵泡刺激素(FSH)和雌二醇(E2)水平,在术后进行2年随访,比较各组1年和2年累计妊娠率,并观察药物不良反应。结果三组临床总有效率比较,差异无统计学意义(P>0.05)。三组术前血清CA125水平比较,差异无统计学意义(P>0.05),术后CA125水平均显著降低(P<0.05),且A组血清CA125明显低于B和C组(P<0.05);B组复发率显著高于C组(P<0.05),C组并发症发生率显著高于A组和B组(P<0.05)。三组术前各项激素水平比较,差异无统计学意义(P>0.05),术后均显著降低(P<0.05),其中A组和C组FSH、LH、E_2水平显著低于B组(P<0.05)。B组和C组1年累计妊娠率、2年累计妊娠率均略高于A组,但三组1年和2年累计妊娠率比较,差异无统计学意义(P>0.05)。三组不良反应比较,差异无统计学意义(P>0.05)。结论孕三烯酮、米非司酮和GnRHa 3种药物方案用于重度EMs术后治疗效果较好,但在复发、并发症、激素水平及妊娠率方面各有优缺点,临床可根据患者实际情况选择最佳药物治疗方案。 Objective To investigate the curative effect of different drug treatment programs on severe endometriosis (EMs) and its influence on the reproductive capacity of patients. Methods A total of 109 patients with severe EMs admitted during the period of September 2014 to July 2016 in Chen Xinghai Hospital were enrolled in this study. All patients received surgery and postoperative medication voluntarily. Patients were divided into groups according to their choice of different drug treatment plans. Group A (35 cases) was treated with Gestrinone. Group B (41 cases) was treated with mifepristone. Group C (33 cases) was treated with gonadotropin-releasing hormone (GnRHa) treatment. The curative effect, serum CA125 level, relapse and complication of the three groups were compared. The levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2) were measured in three groups before and after operation for 2 years. The cumulative pregnancy rates of 1 year and 2 years in each group were compared Adverse drug reactions observed. Results The total clinical efficiency of the three groups, the difference was not statistically significant (P> 0.05). The serum levels of CA125 in the three groups were significantly lower than those in the B and C groups (P <0.05), while there was no significant difference between the three groups (P> 0.05) . The recurrence rate of group B was significantly higher than that of group C (P <0.05). The complication rate of group C was significantly higher than that of group A and group B (P <0.05). The levels of FSH, LH and E 2 in group A and group C were significantly lower than those in group B (P <0.05), and the levels of FSH, LH and E 2 in group A and group C were significantly lower than those in group B P <0.05). The 1-year cumulative pregnancy rate and 2-year cumulative pregnancy rate in group B and group C were slightly higher than those in group A, but there was no significant difference in the cumulative pregnancy rates between the 1-year and 2-year groups (P> 0.05). Adverse reactions in the three groups, the difference was not statistically significant (P> 0.05). Conclusion Gestrinone, mifepristone and GnRHa are effective in the treatment of severe EMs after operation, but they have advantages and disadvantages in relapse, complications, hormone levels and pregnancy rate. The clinical practice can be based on actual patients Choose the best drug treatment program.