GnRHa联合等离子宫腔镜在粘膜下子宫肌瘤切除中的应用

Application of GnRHa combined with plasma kinetic technique in hysterocopic section of submucosal myomas

目的 评价应用促性腺激素释放激素类似物（GnRHa）联合等离子宫腔镜治疗子宫黏膜下肌瘤的优势和安全性.方法 GnRHa组术前应用GnRHa联合宫腔镜双极电切除子宫黏膜下肌瘤26例（0型或1型,其中0型17例）,肌瘤直径约2.2~4.5cm;非GnRHa组术前不采用GnRHa直接用等离子宫腔镜双极电切除子宫黏膜下肌瘤22例（0型或1型,其中0型13例）,肌瘤直径2.1～4.2cm.结果 GnRHa组术中膨宫液总用量2 500～5 000mL,平均3 200mL,平均膨宫液吸收量820±142mL,手术时间20～70min,平均43±15min,术中出血量20mL,非GnRHa组患者术中膨宫液总用量2 800～7 000mL,平均5 000mL,平均膨宫液吸收量1 450±235mL,手术时间35～85min,平均58±18min,术中出血量50mL,术后随访3个月,2组患者均无明显肌瘤复发.结论 GnRHa联合等离子宫腔镜电切治疗子宫黏膜下肌瘤具有安全、损伤小、恢复快、高效率等特点,宜于推广.

Objective To evaluate the advantages and safety of GnRHa combined with plasma kinetic technique in the treatment of submucosal myomas of uterus. Methods With GnRHa pre-operative treatment 26 cases of submucous myomas （GnRHa group） underwent hysteroscopic transcervical resection of myoma （TCRM） with bipolar electrodes （including 17 cases of type 0 submucous myoma,9 cases of type I）, another 22 cases （non-GnRHa group） underwent TCRM with bipolar electrodes （including 13 cases of type 0 submueous myoma, 9 cases of type I） without GnRHa pre-operative treatment. The diameter of myomas in GnRHa group and non-GnRHa group was 2.2-4.5cm and 2.1-4.2cm respectively. Results Total volume of uterine distention fluid in GnRHa group was 2 500-5 000mL, with the average volume of 3 200mL. In this group the average uterine distention fluid absorbed was 820 ± 142mL, the average operation time was 43 ± 15min （20-70min）, and the operative blood loss was 20mL. Total volume of uterine distention fluid in non-GnRHa group was 2 800- 7 000mL, with the average volume of 5 000mL. The average uterine distention fluid absorbed was 1 450 ± 235mL, the average operation time was 58 ± 18min （35-85min）, and the operative blood loss was 50mL in non-GnRHa group. All of the patients were followed up for 3 months, and no obvious submucosal myomas recurred in both groups. Conclusion GNRHa combined with plasma kinetic technique in TCRM has characteristics of safety, minimal invasion, quick recovery and high efficiency, so it is worthy of being recommended.