腹腔镜下大子宫肌瘤剔除术术前应用GnRH-a治疗的效果观察

Effect observation of applying Gn RH-a before myomectomy in large uterus under laparoscope

目的：探讨促性腺激素释放激素激动剂（GnRH-a）在子宫体积〉孕12周子宫肌瘤患者行腹腔镜子宫肌瘤剥除术前使用的效果。方法选取本院2007年1月～2012年12月收治的25例子宫体积〉孕12周的子宫肌瘤患者作为研究对象，术前给予亮丙瑞林皮下注射3针。观察治疗前后子宫及肌瘤体积的改变情况、血红蛋白水平的变化以及术中出血量，随访术后子宫肌瘤的复发情况。结果25例患者治疗后子宫肌瘤体积明显缩小，治疗前B超检查测定的平均体积为（121.7±70.53） cm3，治疗后为（78.3±42.4） cm3，肌瘤体积缩小35.6%，差异有统计学意义（P〈0.05）。治疗前的子宫平均体积为（386.9±82.1）cm3，治疗后为（253.5±56.4）cm3，差异有统计学意义（P〈0.05）。GnRH-a治疗前的血红蛋白值为（88.7±31.2）g/L，治疗后为（119.3±21.5）g/L，差异有统计学意义（P〈0.05）。所有手术均顺利完成，无一例中转开腹。结论术前使用亮丙瑞林3个月，可以显著缩小大子宫肌瘤患者的肌瘤及子宫体积，纠正贫血，减少术中出血，降低术后复发，能够使腹腔镜子宫肌瘤剥除术顺利进行。

Objective To explore the effect of applying gonadotropin-releasing hormone agonist （GnRH-a） before la-paroscopic myomectomy in uterine volume over 12 gestational weeks patients with uterine myoma before myomectomy in large uterus under laparoscope. Methods 25 uterine volume over 12 gestational weeks patients with uterine myoma from January 2007 to December 2012 in our hospital were selected as the research objects.Three-needle leuprolide via subcutaneous injection was used before surgery.The change of volume in uterus and myoma before and after medication were observed.The change of hemoglobin level and intraoperative amount of bleeding were observed and postoperative recurrence of uterus myoma was followed up. Results The volume of uterus myoma after treatment in 25 patients was greatly shortened,the average volume detected by B ultrasound after treatment was （121.7±70.53） cm3,the average vol-ume before treatment was （78.3±42.4） cm3,and the volume of myoma shortened by 35.6%,with significant difference （P〈0.05）.The average volume of the uterus before treatment was （386.9±82.1） cm3,the average volume of the uterus after treatment was （253.5±56.4） cm3,with significant difference （P〈0.05）.The hemoglobin value before GnRH-a treatment was （88.7±31.2） g/L,the hemoglobin value after GnRH-a treatment was （119.3±21.5） g/L,with significant difference （P〈0.05）. The surgeries were all successful,and no case was transferred to laparotomy. Conclusion Application of leuprorelin for 3 months before surgery can greatly shorten volumes of myoma and uterus,correct anemia,reduce postoperative recurrence of uterus myoma and intraoperative amount of bleeding,which ensures smooth performance of laparoscopic myomectomy.