GnRHa用于大子宫子宫肌瘤腹腔镜手术前治疗疗效的前瞻性研究

Effects of Pre-Operative Gonadotropin Releasing Hormone Agonists( Goserelin) for Uterine Fibroids Women with Large Uterine Undergoing Laparoscopic Surgery: A Prospective Study

目的：评价对于子宫体积＞孕14周的子宫肌瘤患者术前使用促性腺激素释放激素激动剂（GnRHa）的疗效,及治疗后对腹腔镜微创手术的影响.方法：收集2009年1月至2013年9月北京协和医院收治子宫体积＞孕14周的子宫肌瘤患者共22例.术前予戈舍瑞林皮下注射2针（1针/28天）.停药30 ～ 60天进行腹腔镜全子宫切除术或肌瘤剔除术.记录药物治疗前后的肌瘤体积、血红蛋白水平改变,以及术中出血量、输血情况.结果：22例患者在GnRHa治疗前血红蛋白均值为92.2±22.0 g/L,治疗后为122.6±14.0g/L,血红蛋白平均升高30.5±21.9 g/L,差异有统计学意义（P＜0.01）.GnRHa治疗前B超检查测定子宫肌瘤平均体积138.5±137.0 cm3,治疗后体积88.5±64.6 cm3,体积缩小的均值为50.0±89.2 cm3,较用药前体积减少36.1％,差异有统计学意义（P＜0.05）.所有患者均采用腹腔镜完成手术,无中转开腹者,其中输血1例（4.5％）.结论：在子宫体积＞孕14周的子宫肌瘤患者中,术前使用2个月戈舍瑞林治疗可以显著提高血红蛋白水平,显著缩小肌瘤体积,并使患者得以使用微创的腹腔镜手术完成治疗.

Objective：To evaluate the curative effect of gonadotropin-releasing hormone agonists（GnRHa）in treating myoma patients with large uterus like 14 weeks of pregnancy size,and to explore the effect of the medical treatment on the laparoscopy（keyhole surgery）treatment. Methods： In this prospective study,22 uterine fibroids patients with a large uterus （ 〉 14 weeks）were admitted to obstetric and gynecologic department, PUMCH from January 2009 to September2013. All of these patients received two doses goserelin acetate（zoladex）subcutane- ously before operation. Laparoscopic hysterectomy or myomectomy was done by the same gynecologist in 30 -60 days since the last dose of zoladex. Change in uterine volume, hemoglobin level, blood loss and blood transfu- sions during operation were recorded and analyzed. Results：The average hemoglobin level of 22 patients was 92.2 ＋22.0 g/L before GnRHa treatment, and 122.6 ± 14.0 g/L after GnRHa treatment（ P 〈0. 01 ） ,the average increase of hemoglobin level was 30.5 ±21.9 g/L. The average of volume of fibroids was 138.5 ±137.0 cm3 be- fore GnRHa treatment and reduced 88.5 ± 64.6 cm3 after treatment（ P 〈 0.05） ,The average reduce of volume was 50.0 ±89.2 cm3 ,volume was reduced by 36. 1%. All patients underwent laparoscopic surgeries successfully with one（4. 5% ） of them received transfusion,and no one converted to laparotomy. Conclusions.In uterine myoma patients with uterine larger than 14 gestational weeks, pre-operative treatment of 2 doses of goserelin could increase the hemoglobin level significantly and reduce the volume of uterine fibroids,which makes minimal invasive laparoscopic surgery practicable.