用促性腺激素释放激素类似物预处理后腹腔镜行子宫肌瘤切除术的分析

Analysis of the efficacy of GnRH-a agonist therapy before laparoscopic hysteromyomectomy.

目的分析经用促性腺激素释放激素类似物(GnRH-a)预处理后,腹腔镜行子宫肌瘤切除术的手术效果、适应证及并发症。方法回顾性分析直径大于5 cm肌瘤的腹腔镜肌瘤切除术,其中28例术前给予曲普瑞林醋酸盐(diphereline,达菲林)(研究组),36例未用药(对照组),比较两组的手术时间、术中出血量及手术并发症等。结果①研究组中每例患者肌瘤1-2个,共切除肌瘤32个,未用药前超声测量肌瘤平均直径为6．5 cm;切除术后平均直径为3．2 cm。对照组中每例患者肌瘤1-3个,共切除肌瘤41个, 术前超声测量肌瘤平均直径为5．9 cm;切除术后测量平均直径为5．7 cm。术前两组肌瘤直径比较,差异无显著意义(P>0．05),切除术后两组肌瘤直径比较,研究组肌瘤直径明显缩小,肌瘤体积平均缩小率51％, 两组比较差异有显著意义(P<0．01)。②研究组中有9例进行了缝合,手术时间为(45±18)min,出血量为 (60±25)ml;对照组中有12例进行了缝合,手术时间为(92±32)min,出血量为(110±105)ml,两者比较, 研究组手术时间及出血量均明显减少,差异有显著意义(P<0．01,P<0．05)。③研究组、对照组组术后平均住院时间分别为4．2 d及4．8 d,术后2个月后随访,两组术前有症状者术后均改善。研究组1例术后1+ 年肌瘤复发,再次行腹腔镜子宫肌瘤切除术。结论对于较大体积的子宫肌瘤术前应用GnRH-a 3个月,可明显缩小肌瘤体积,缩短手术时间,减少术中出血量。

Objective Analyse about the effect, application and the contraindication of GnRH-a agonist therapy before laparoscopic hysteromyomectomy. Methods A retrospective study of laparoscopic hysteromyomectomy of the leiomyoma is longer than 5 cm. Of them 28 cases given GnRH-a （investigation group） ,36 cases without any disposal（comparison group）,compare the operation time, bleeding quantity and the operation syndrome of the 2 groups. Results ①In the investigation group, every case includes 1 - 2 leiomyoma, aggregately 32 leiomyoma was excised. Without any drug diameter of the average leiomyoma is 6. 5 cm, after the resection the diameter of the average leiomyoma is 3. 2 cm; in the comparison group, every case 1 - 3 leiomyoma. Without any drug diameter of the average leiomyoma is 5. 9 cm, after the resection the average diameter of the leiomyoma is 5.7 cm. Before the operation there＇s no notable difference between the 2 groups of the diameter（P〉0.05）. After the operation, the diameter of the investigation group is remarkably shorten. There＇s notable difference （P 〈 0. 01 ）. ② In the investigation group, there are 9 cases were sewed up, operation time is （45± 18） minutes and average bleeding quantity is （60±25） ml. In the comparison group, there are 12 cases were sewed up, operation time is （92±32） minutes and average bleeding quantity is （110±105） ml. The operation time and the bleeding quantity of the investigation group is remarkably reduced （P 〈 0. 01, P 〈 0. 05）. ③ the investigation group and the comparison group treatment time is separately 4. 2 and 4. 8 days. 2 months after the operation, the sufferers of 2 groups both mended. 1 case of the investigation group was resected with celioscope again in 1＋ year. Conclusion Applying GnRH-a 3 months before the operation to those bigger leiomyoma can remarkably reduce the volume of the leiomyoma, operation time and bleeding quantity.