腹腔镜子宫肌瘤剔除术前米非司酮预处理的临床效果观察

Clinical effect of mifepristone pretreatment before laparoscopic myomectomy

目的观察腹腔镜下子宫肌瘤剔除术前应用米非司酮预处理的临床效果。方法选取150例子宫肌瘤患者,采用信封法随机分为2组,每组75例,对照组患者采用常规腹腔镜下子宫肌瘤剔除术,观察组患者在采用腹腔镜下子宫肌瘤剔除术前先采用米非司酮进行预处理,即在术前采用12.5 mg/d服用,连续服用3个月。观察比较观察组米非司酮预处理前后及对照组术前肌瘤直径大小,观察比较两组患者手术情况,包括手术时间、术中出血量、术中输血率、术后血红蛋白及术后住院时间。观察组在采用米非司酮治疗期间,严密监测患者肝肾功能,并观察患者有无其他不良反应发生。结果观察组预处理前肌瘤直径为(5.6±2.5)cm,预处理后肌瘤直径为(3.2±1.5)cm,对照组术前肌瘤直径为(5.7±2.6)cm,观察组预处理后较预处理前及对照组术前均明显缩小(P<0.05)。观察组手术时间、术中出血量、术中输血率均明显低于对照组(P<0.05),两组患者术后血红蛋白及住院时间比较差异无统计学意义。观察组患者5例(6.67%)在服药早期有轻度恶心症状,3例(4.00%)天冬氨酸氨酶轻度升高,无其他严重不良反应。结论米非司酮预处理应用于腹腔镜下子宫肌瘤剔除术中可明显缩小肌瘤体积,缩短手术时间,减少术中出血。

Objective To observe the clinical results of laparoscopic myomectomy before mifepristone pre- treatment. Methods 150 patients with uterine fibroids were randomly divided into two groups ,75 cases in the control group were treated with conventional laparoscopic myomectomy, 75 cases in the observation group used laparoscopic myomectomy before using mifepristone pretreatment, preoperative 12. 5 mg/d, once a day for three months. The myoma diameter before and after mifepristone pretreatment of observation group and preoperative of control group, and the sur- gery, including operative time, blood loss, intraoperative blood transfusion rate, postoperative hospital stay and postoper- ative hemoglobin time of the two groups were observed and compared. Liver and kidney function of observation group was closely monitored during mifepristone treatment period, and observed whether or not there were other adverse reac- tions. Results The myoma diameter of observation group before and after mifepristone pretreatment were （5.6 ± 2. 5 ） cm and （ 3.2 ± 1.5 ） cm respectively,preoperative of control group was （5.7 ± 2. 6） cm, the observation group before treatment was significantly reduced compared with after treatment and control group pretreatment （ P 〈 0. 05 ）. The op- erative time, blood loss, intraoperative blood transfusion rate of observation group were significantly lower than those of control group （ P 〈 0. 05 ）, postoperative hemoglobin and hospital stay time had no significant difference between the two groups. Observation group had 5 cases （6. 67% ） mild nausea in the early of medication,3 cases （4. 00% ） mildly elevated aspartate ammonia lyase, and no other serious adverse reactions. Conclusion Laparoscopic mifepristone pre- treatment in myomectomy can significantly reduce fibroid volume,shorten operative time,reduce blood loss.