腹腔镜下子宫肌瘤剔除术术前给予醋酸亮丙瑞林预处理的有效性和安全性

Efficacy and safety of pretreatment with leuprorelin acetate before laparoscopic myomectomy

目的探讨腹腔镜下子宫肌瘤剔除术术前给予醋酸亮丙瑞林预处理的有效性和安全性。方法选择2015年1月至2017年12月我院妇产科收治的120例子宫肌瘤患者,采用随机数字表法将其分为对照组和观察组,每组60例。对照组直接行腹腔镜下子宫肌瘤剔除术,观察组先给予醋酸亮丙瑞林预处理,再行腹腔镜下子宫肌瘤剔除术。比较两组子宫和子宫肌瘤体积、手术情况、术后恢复情况、性激素指标、微循环指标及术后复发率。结果观察组用药后的子宫和子宫肌瘤体积均小于用药前和对照组,差异具有统计学意义(P<0.05)。观察组手术时间、盆腔引流时间、离床活动时间、住院时间均短于对照组,术中出血量少于对照组,差异具有统计学意义(P<0.05)。观察组用药后的LH、FSH、E2水平、血流灌注指数、甲襞微循环积分均高于用药前和对照组,差异具有统计学意义(P<0.05)。术后随访1年,观察组复发率显著低于对照组,差异具有统计学意义(P<0.05)。结论腹腔镜下子宫肌瘤剔除术术前应用醋酸亮丙瑞林预处理可有效减小子宫肌瘤患者的子宫体积和肌瘤体积,改善患者微循环,纠正性激素紊乱,加快术后恢复,减少复发,值得临床推广应用。

Objective To investigate the efficacy and safety of pretreatment with leuprorelin acetate before laparoscopic myomectomy. Methods From January 2015 to December 2017, 120 patients with hysteromyoma admitted in the gynaecology and obstetrics of our hospital were selected and divided into control group and observation group according to random number table method, with 60 cases in each group. The control group received laparoscopic myomectomy, the observation group received leuprorelin acetate pretreatment, and then laparoscopic myomectomy. The volume of uterus and hysteromyoma, operation, postoperative recovery, sex hormone index, microcirculation index and recurrence rate were compared between the two groups. Results The volume of uterus and hysteromyoma in the observation group after medication were smaller than those before medication and in the control group, and the differences were statistically significant(P <0.05). The operation time, pelvic drainage time, activity time out of bed and hospitalization time in the observation group were shorter than those in the control group, and the intraoperative blood loss was less than that in the control group, the differences were statistically significant(P<0.05). The levels of LH, FSH, E2, blood flow perfusion index and nail fold microcirculation integral in the observation group after medication were higher than those before medication and in the control group, the differences were statistically significant( P <0.05). One year follow-up, the recurrence rate of the observation group was significantly lower than that of the control group, and the difference was statistically significant(P <0.05). Conclusion Pretreatment with leuprorelin acetate before laparoscopic myomectomy can effectively reduce the volume of uterus and myoma, improve microcirculation of patients, correct sexual hormone disorder, accelerate postoperative recovery and reduce recurrence, which is worthy of clinical application.