子宫肌瘤大于孕14周体积患者术前使用促性腺激素释放激素激动剂的效果评价

Effect of pre- operative gonadotropin releasing hormone agonists to myoma patients with large uterusof over 14 weeks' pregnancy size

目的:研究术前使用促性腺激素释放激素激动剂(GnRHa)对提升子宫体积>14孕周子宫肌瘤患者手术效果的临床价值。方法:将2010年1月至2014年1月于我院择期手术、子宫体积>14孕周的子宫肌瘤患者纳为观察组(n=20),术前行GnRHa皮下注射处理,停药3个月后行腹腔镜手术;择同期行腹腔镜手术、子宫体积≤14孕周的子宫肌瘤患者为对照组(n=20)。统计对比两组患者子宫及肿瘤体积、血红蛋白(Hb),以评价GnRHa预处理效果;统计对比两组手术时间、术中出血量、输血情况等指标,以评价手术效果。结果:(1)观察组患者用药后Hb水平明显升高而子宫及肌瘤体积明显下降(P<0.05);两组患者手术前Hb水平、肌瘤体积无明显差异(P>0.05),观察组子宫体积仍明显大于对照组(P<0.05);(2)所有患者均成功完成腹腔镜手术,无中转开腹患者;两组手术时间、术中出血量、输血例数差异均无统计学意义(P<0.05);两组均未见严重术中及术后并发症,观察组均出现GnRHa相关不良反应,但均未影响手术效果。结论:行GnRHa预处理,可有效降低子宫体积>14孕周子宫肌瘤患者的肿瘤体积,并提升Hb水平,从而使患者满足腹腔镜手术指征,保证腹腔镜手术效果,提升患者预后。

Objectives：To study the clinical effect on increasing operation effect by pre -operative applying gonadotropin releasing hormone agonist （GnRHa）to myoma patients with large uterus of over 1 4 weeks’pregnancy size.Methods：20 myoma patients with large uterus of over 1 4 weeks’pregnancy size in our hospital from Jan. 201 0 to Jan.201 4 were selected as the observation group.They received preoperative GnRHa subcutaneous injec-tion,and laparoscopic surgery after 3 months of pre -operative process.20 patients accepted by our hospital in the same time,whose uterus were not larger than 1 4 weeks’pregnancy size,were chosen as the control group.Their u-terus and tumors volume,as well as hemoglobin level （Hb）were recorded in order to show the effect of pre -opera-tive applying GnRHa.Their operative time,bleeding volume,blood transfusion and other indicators of surgery were also recorded to evaluate the effect of operation.Results：i.The levels of Hb in patients of observation group after treatment increased obviously and uterine and fibroid volume decreased significantly （P 〈0.05）.Before surgery, the Hb level and the tumor volume of patients in the two groups showed no significant difference （P 〉0.05）,but the uterus volume of patients in observation group were larger than the that of the control group （P 〈0.05）;ii.All patients successfully completed laparoscopic surgery,with no patients conversed into open surgery.The difference in operative time,amount of bleeding and number of blood transfusion patients in the two groups were not statistically significant （P 〈0.05）.There were no serious intraoperative and postoperative complications in both groups.All pa-tients in observation group showed adverse reactions related to GnRHa,but did not influence the effect of operation. Conclusion：The pre -operation applying of GnRHa can effectively reduce the volume of uterus and tumor size in myoma patients with large uterus of over 1 4 weeks’pregnancy size.Thus it can make patients meet the laparoscopic surgical indications,ensure the effect of laparoscopic operation,and improve the prognosis of the patients.