亮丙瑞林结合腹腔镜子宫肌瘤剔除术治疗子宫肌瘤疗效及对患者卵巢功能、术后复发影响

Efficacy of leuprorelin combined with laparoscopic myomectomy for treating patients with uterine myoma and its influence on the pelvic ovarian function and postoperative recurrence

目的:观察亮丙瑞林结合腹腔镜子宫肌瘤剔除术治疗子宫肌瘤疗效及对患者卵巢功能、术后复发的影响。方法:纳入2019年3月-2022年6月本院收治的子宫肌瘤患者162例,随机数字表法分为对照组和观察组各81例,对照组单纯腹腔镜子宫肌瘤剔除术治疗,观察组术前3个月始皮下注射醋酸亮丙瑞林,并腹腔镜子宫肌瘤剔除术治疗,比较两组手术相关指标、术后并发症,术前3个月及术后3个月比较患者子宫体积、血清雌二醇(E_(2))、促黄体生成素(LH)、促卵泡激素(FSH)等卵巢功能指标变化,盆底功能障碍问卷(PFDI-20)评估患者盆底功能,随访术后6、12个月子宫肌瘤复发率。结果:观察组术中出血量、手术时间、引流时间、下床活动时间均少于对照组(P<0.05),两组术后并发症率均较少且无差异(1.2%、3.7%)(P>0.05);观察组药物预处理后子宫肌瘤体积缩小(89.62±6.23cm^(3))且小于对照组(112.12±6.20cm^(3)),术后3个月观察组子宫体积(181.53±8.47cm^(3))、E2(151.24±8.43pmol/L)、LH(10.39±1.85U/L)、FSH(13.58±2.16U/L)及PFDI-20评分均优于对照组(190.54±9.54cm^(3)、168.47±9.34pmol/L、12.60±2.85U/L、15.39±3.05U/L)(均P<0.05);肌瘤复发率,术后6个月两组无差异(P>0.05),术后12个月观察组(0)低于对照组(5.0%)(P<0.05)。结论:亮丙瑞林结合腹腔镜子宫肌瘤剔除术治疗子宫肌瘤效果更佳,患者术后盆底功能、卵巢功能恢复指标提高,术后12个月肌瘤复发率降低,未增加并发症用药安全。

Objective:To observe the efficacy of leuprorelin combined with laparoscopic myomectomy for treating patients with uterine myoma,and to study its influence on the pelvic ovarian function and postoperative recurrence of the patients.Methods:A total of 162patients with uterine myoma were selected and were divided into control group(81 cases)and observation group(81cases)by random number table method from March 2019to June 2022.The patients in the control group were given treatment of laparoscopic myomectomy alone,and the patients in the observation group were given treatment of subcutaneous injection of leuprelin acetate in 3months before surgery combined with laparoscopic myomectomy.The values of the operative related indexes and the postoperative complications rate of the patients were compared between the two groups.The changes of the uterine volume and the levels of estradiol(E2),luteinizing hormone(LH),and follicle-stimulating hormone(FSH)of the patients in 3months before and after surgery were compared between the two groups.Pelvic floor Dysfunction Questionnaire(PFDI-20)was used to evaluate the pelvic floor function of the patients in the two groups.The recurrence rates of the patients in the two groups were followed up in 6months and in 12months after surgery.Results:The intraoperative blood loss,the operation time,the drainage time,and the activity time of getting out of bed of the patients in the observation group were significantly less than those of the patients in the control group(P<0.05).There was no significant difference in the incidence of postoperative complications(1.2%vs.3.7%)of the patients between the two groups(P>0.05).After drug pretreatment,the volume of uterine myoma(89.62±6.23cm^(3))of the patients in the observation group had decreased,and which was significantly less than that(112.12±6.20cm^(3))of the patients in the control group.Three months after operation,the uterine volume(181.53±8.47cm^(3)),the levels of E2(151.24±8.43pmol/L),LH(10.39±1.85U/L)and FSH(13.58±2.16U/L),and the PFDI-20score of the patients in the observation group were significantly less than those(190.54±9.54cm^(3),168.47±9.34pmol/L,12.60±2.85U/L and 15.39±3.05U/L)of the patients in the control group(all P<0.05).There was no significant difference in the recurrence rate of uterine myoma of the patients in 6months after operation between the two groups(P>0.05).The recurrence rate of uterine myoma(0)of the patients in the observation group in 12months after operation was significantly lower than that(5.0%)of the patients in the control group(P<0.05).Conclusion:Leuprorelin combined with laparoscopic myomectomy for treating patients with uterine myoma has better efficacy,and which can improve their pelvic floor function and ovarian function recoveries and can reduce the recurrence rate of the uterine myoma of the patients in 12months after operation,and without increase of the complications and with medication safety.