GnRHa联合腹腔镜下巨大子宫肌瘤核除新技法对术后生育功能的影响

The Effect of Improved Laparoscopic Myomectomy Combined Leuprorelin( GnRHa) on Reproductive Function of Giant Hysteromyoma

目的综合评估经过系统改良后的腹腔镜技术对治疗巨大子宫肌瘤的安全性和有效性。方法在2013年6月-2016年6月住院的巨大子宫肌瘤术后患者中,收集出院后2年间寻求自然分娩的27例待产患者作为观察组,在2010年6月-2013年6月住院的巨大子宫肌瘤术后患者中,收集出院后2年间寻求自然分娩的21例待产患者作为对照组。两组患者住院期间均接受独立完成的腹腔镜手术。观察组采用系统改良后的治疗模式,包括术前使用亮丙瑞林3个月,术中采用原位旋切技法操作,并应用Quill线缝合肌瘤残腔。对照组采用传统手段和技法开展治疗。在子宫切口长度,缝合子宫耗时,手术耗时,术中出血量,留置盆腔引流时间,住院时间,术后并发症等方面收集首轮数据。术后均随访2年,在术后月经恢复时间,术后受孕时间,自然受孕人数,足月妊娠人数,子宫破裂/转剖宫产人数等方面收集数据。利用SPSS 22. 0软件进行分析处理。结果两组数据在子宫切口长度,缝合子宫耗时,手术耗时,术中出血量,留置盆腔引流时间等方面的差异有统计学意义(P <0. 05),但在住院时间,术后并发症方面差异没有统计学意义(P> 0. 05)。通过2年随访,两组数据在术后受孕时间方面的差异有统计学意义(P <0. 05),在术后月经恢复时间,自然受孕人数,足月妊娠人数,子宫破裂/转剖宫产人数等方面的差异没有统计学意义(P> 0. 05)。结论实践初步证明,系统改良后的腹腔镜治疗巨大子宫肌瘤治疗新模式对术后妊娠及分娩的影响是积极,安全和有效的。

Objective Evaluation of effectiveness and safety about improved laparoscopy on giant hysteromyoma.Methods Collecting of 27 Improved Laparoscopic( 2013-2017) Myomectomies combined Leuprorelin( GnRHa) who are seeking natural birth in 2 years,as A group. Collecting of 21 traditional Laparoscopic( 2010-2013) Myomectomies who are seeking natural birth in 2 years,as B group. All cases are waiting for dilivery after operation on giant hysteromyoma. To adopt comprehensive improvement model in A group,using of Leuprorelin( GnRHa) for three months before operation,making a measure of in-situ rotary cutting,Suture the residual cavity of uterus with Quill suture.Collecting some data,including the length of the incision of uterus,Suture uterus time,operation time,the bleeding,the drainage time of pelvic,time consuming in hospital,the postoperative complications. Have the follow-up of all patients after the hospital for 2 years. Collecting other data,including the time of restore menstruation,pregnant time after the hospital,the number of natural conception,the number of full-term pregnancy,the number of uterine rupture or cesarean delivery. Results Comparison between group A and B,the length of the incision of uterus( t = 6. 158,P =0. 000),Suture uterus time( t = 11. 565,P = 0. 000),operation time( t =-14. 901,P = 0. 000),the bleeding( t =9. 139,P = 0. 000),the drainage time of pelvic( t = 8. 201,P = 0. 000),time consuming in hospital( t =-1. 826,P =0. 080),the postoperative complications( χ^2= 0. 683,P = 0. 574),the time of restore menstruation( t =-1. 471,P =0. 157),pregnant time after the hospital( t = 8. 538,P = 0. 000),the number of natural conception( χ^2= 0. 033,P =1. 000),the number of full-term pregnancy( χ^2= 0. 069,P = 1. 000),the number of uterine rupture or cesarean delivery( χ^2= 0. 683,P = 0. 574). Conclusions The Effect of improved Laparoscopic Myomectomy combined Leuprorelin( GnRHa) on Reproductive Function of Giant Hysteromyoma is preliminarily proved to be feasible and effective.