腹腔镜下子宫肌瘤剔除术联合术前应用促性腺激素释放激素激动剂治疗大子宫肌瘤的疗效观察*

Clinical observation of laparoscopic myomectomy combined with preoperative GnRH-a in treating leiomyoma with large uterus*

摘要:

目的??分析腹腔镜下子宫肌瘤剔除术联合术前应用促性腺激素释放激素激动剂（GnRH-a）治疗子宫体积>孕12周子宫肌瘤的治疗效果。方法?选取该院2009年8月-2016年8月收治的子宫体积>孕12周的46例子宫肌瘤患者作为研究对象，术前给予亮丙瑞林皮下注射3～6针，治疗后1个月行腹腔镜下子宫肌瘤剔除术。观察药物治疗前后子宫及肌瘤体积的变化、血红蛋白的变化、肌瘤相关症状的变化、用药后的副反应、术中出血量、手术时间、住院时间、术后有无并发症和随访术后肌瘤是否复发等情况。结果?46例患者在GnRH-a治疗前B超检查测定子宫平均体积（705.47±282.37）cm3，治疗后平均体积（331.95±84.53）cm3，缩小59.35%，差异有统计学意义（P <0.05）。GnRH-a治疗前B超检查测定子宫肌瘤平均体积（237.59±138.46）cm3，治疗后平均体积（81.59±46.44）cm3，缩小65.66%，差异有统计学意义（P <0.05）。GnRH-a治疗前血红蛋白值为（97.80±20.19）g/L，治疗后血红蛋白值为（119.63±12.06）g/L，差异有统计学意义（P <0.05）。所有手术均顺利完成，无1例中转开腹。术后随访时间3个月～5年，均恢复良好，无明显手术并发症。结论?术前应用GnRH-a治疗子宫肌瘤，可以显著缩小肌瘤体积、提高患者血红蛋白水平，从而使子宫体积>孕12周的肌瘤患者能够完成保留子宫的微创手术。

Abstract:

Objective?To evaluate the curative effect of laparoscopic myomectomy combined with preoperative gonadotropin releasing hormone agonists (GnRH-a) in treating myoma patients with uterus volume large than 12 weeks of pregnancy size.?Methods?46 patients with uterine volume over 12 gestational weeks from August 2009 to August 2016 were selected as research objects. Leuprolide was injected subcutaneously for three to six times, and then laparoscopic myomectomy was performed one month later. The changes of volumes in uterus and myoma before and after medication were observed as well as the changes of hemoglobin. And postoperative recurrence of uterus myoma was followed up.?Results?The average volume of the uterus in the 46 patients, detected by B ultrasound, before GnRH-a treatment was (705.47 ± 282.37) cm3, and the average volume of the uterus after GnRH-a treatment was (331.95 ± 84.53) cm3, which was shortened by 59.35%, with significant difference (P < 0.05). The volume of uterus myoma was (237.59 ± 138.46) cm3 before GnRH-a treatment and (81.59 ± 46.44) cm3 after GnRH-a treatment, shortened by 65.66%, with significant difference (P < 0.05). The hemoglobin value was (97.80 ± 20.19) g/L before GnRH-a and (119.63 ± 12.06) g/L after GnRH-a treatment, with significant difference (P < 0.05). Follow-up for 3 weeks to 5 years, the surgeries were accomplished successfully, and no case was transferred to laparotomy. ?Conclusion?Preoperative GnRH-a could shorten volume of uterus myoma, increase hemoglobin value and ensure performance of laparoscopic myomectomy for myoma patients with uterus volume large than 12 weeks of pregnancy size.