LAVH巨大子宫切除联合GnRH-a治疗的对比研究

A COMPARATIVE STUDY OF LAPAROSCOPIC ASSISTED VAGINAL HUGE HYSTERECTOMY COMBINED WITH GNRH-A TREATMENT

目的评估促性腺激素释放激素(GnRH)激动剂治疗是否有利于腹腔镜辅助阴式手术(LAVH)切除巨大子宫,探讨临床应用价值。方法选取该院2014年1月—2016年6月收治巨大子宫(子宫体积≥12孕周)病例75例,均行腹腔镜辅助阴式子宫切除术,分为观察组36例(手术联合GnRH-a治疗)和对照组39例(单纯手术)。比较观察组GnRH-a治疗前后临床症状、血红蛋白浓度和子宫体积大小变化;比较二组手术相关指标。结果观察组GnRH-a治疗后可缩减巨大子宫体积,改善贫血,控制症状;观察组较对照组手术时间缩短,术中出血量减少,差异有统计学意义。结论对于巨大子宫病例,术前GnRH-a治疗可缩减子宫体积,减少血供,控制临床症状,降低手术难度,增加手术安全性和可靠性,具有重要的临床意义。

Objective To evaluate the gonadotropin releasing hormone （GnRH） agonist treatment whether it is beneficial to laparoscopic assisted vaginal hysterectomy for the removal of large uterus, and to explore the clinical significance of GnRH - a combined with surgical treatment in the treatment of huge hysterecto- my. Methods All 75 large uterine cases selected in authors hospital during the period of January 2014 to June 2016 undergoing laparoscopic assisted vaginal hysterectomy were analyzed. All patients were divided into observation group （operation combined with GnRH - a treatment ） and control group （direct opera- tion）. The changes of clinical symptoms, hemoglobin concentration and uterine volume were compared be- fore and after GnRH - a treatment in the observation group. Clinical data of operation of two groups were compared. Results There were 36 cases in the observation group and 39 cases in the control group,and the difference of general characteristics of cases was not significant. Observation group of patients after GnRH - a treatment could reduce the huge uterine volume, improve anemia and control clinical symptoms. Com- pared with the control group, the operation time and the amount of blood loss were not equivalent in the ob- servation group, and the difference was statistically significant. Conclusions For large uterine cases, pre- operative GnRH-a treatment can reduce uterine volume, reduce blood supply, control clinical symptoms, reduce the difficulty and increase the safety and reliability of the operation. It has important clinical signifi- cance.