GnRH-a联合宫腔镜电切术治疗子宫黏膜下肌瘤

Treatment of submucosal fibroid by GnRH-a combined with hysteroscopic electric resection

目的探讨GnRH-a联合宫腔镜电切术治疗子宫黏膜下肌瘤的临床效果。方法选取2015年1月-2016年6月就诊于兴宁市人民医院妇科行宫腔镜下子宫黏膜下肌瘤电切术的患者60例随机分为术前GnRH-a预处理组(予2次GnRH-a预处理后再进行手术)和对照组(入选后直接进行手术)各30例,对比两组患者手术时间、术中出血量、术中灌注液使用量、术中并发症、术中肌瘤完全切除率、术者对手术的难易程度及满意程度的VSA评分等指标的差异;术后3个月和6个月进行随访,比较两组患者术后复发率、症状改善率的差异。结果与对照组比较,术前予GnRH-a预处理组患者可缩短手术时间、减少术中灌注液使用量、降低手术难度、降低术中并发症发生率和术后复发率,两组差异均有统计学意义(P<0.05);GnRH-a预处理组和对照组患者术中肌瘤完全切除率、术后6个月异常阴道流血症状的改善率差异无统计学意义(P>0.05)。结论术前GnRH-a预处理可在保证临床疗效的前提下降低宫腔镜电切术治疗子宫黏膜下肌瘤的手术难度,减少手术并发症的发生。

Objective To explore the clinical effect of gonadotropin releasing hormone agonist（GnRH-a） combined with hysteroscopic electric resection in treatment of submucosal fibroid.Methods Sixty patients with submucosal fibroid treated by hysteroscopic electric resection in Department of Gynecology in the hospital from January 2015 to June 2016 were selected and randomly divided into GnRH-a pretreatment group and control group,30 patients in each group.The patients in GnRH-a pre-treatment group were treated by GnRH-a for two times,then hysteroscopic electric resection was conducted;the patients in control group were not treated by hysteroscopic electric resection.The operation time,the amounts of blood loss during operation,the volumes of perfusate during operation,intraoperative complications,the complete removal rates of submucosal fibroid during operation,VAS scores of difficulty levels and satisfaction degrees in the two groups were compared.After three and six months of operation,all the patients were followed up,the recurrence rates and improvement rates of symptoms in the two groups were compared.Results Compared with control group,the operation time in GnRH-a pre-treatment group was shorter,the volume of perfusate during operation,difficulty level,the recurrence rate and improvement rate of symptoms decreased,there were statistically significant differences between the two groups（P〈0.05）;there was no statistically significant difference in the removal rate of submucosal fibroid during operation and improvement rate of abnormal vaginal bleeding after six months between the two groups（P〉0.05）.Conclusion Pre-treatment with GnRH-a before operation can reduce the difiiculty level of hysteroscopic electric resection and surgical complications on the premise of ensuring clinical effect.