黏膜下子宫肌瘤宫腔镜手术后曲普瑞林联合维生素D预防治疗的临床评价

Efficacy of triprerelin combined with vitamin D in preventing recurrence of submucous uterine fibroids after B-ultrasound-guided hysteroscopy

目的观察黏膜下子宫肌瘤患者B超引导下宫腔镜术后曲普瑞林联合维生素D预防复发的效果及激素水平、子宫功能恢复情况。方法纳入成都市成华区妇幼保健院、淮安市第五人民医院、安庆市宿松县人民医院102例B超引导下宫腔镜手术治疗的黏膜下子宫肌瘤(2019年3月至2022年1月收治)患者进行分组研究,采取随机数字表法将纳入患者分为两组,对照组患者(51例)B超引导下宫腔镜手术后采取维生素D治疗,观察组患者(51例)在对照组治疗基础上联合曲普瑞林治疗,比较两组的疗效、治疗前后性激素指标变化及子宫内膜厚度、子宫内膜阻力指数变化、术后6个月两组患者子宫体积正常率及月经正常率、术后6个月复发率。结果观察组疗效优于对照组[96.08%(49/51)vs 84.31%(43/51),χ^(2)=3.991,P<0.05]。治疗后,观察组卵泡刺激素(FSH)、黄体生成素(LH)及雌二醇(E2)等性激素指标分别为(5.25±0.28)IU·L^(-1)、(7.97±0.48)IU·L^(-1)、(95.23±5.23)ng·L^(-1),均低于对照组患者[(6.50±0.37)IU·L^(-1)、(9.38±0.58)IU·L^(-1)、(111.52±6.23)ng·L^(-1),t=19.239,13.375,14.302,均P<0.05]。观察组患者治疗后子宫内膜阻力指数低于对照组[(0.42±0.08)%vs(0.66±0.10)%,t=13.384,P<0.05],子宫内膜厚度高于对照组[(8.73±0.31)mm vs(5.34±0.26)mm,t=59.836,P<0.05)]。观察组患者术后6个月子宫体积正常率[92.16%(47/51)vs 76.47%(39/51),χ^(2)=4.744,P<0.05]及月经正常率[94.12%(48/51)vs 80.39%(41/51),χ^(2)=4.320,P<0.05]均高于对照组,术后6个月复发率及术后1年复发率均低于对照组(χ^(2)=4.163,6.375,均P<0.05)。结论曲普瑞林联合维生素D预防黏膜下子宫肌瘤患者B超引导下宫腔镜术后复发效果良好,可较好改善患者性激素水平及子宫内膜情况,促进患者子宫体积及月经恢复正常。

Objective To observe the efficacy of triprerelin combined with vitamin D in preventing recurrence of submucous uterine fibroids after hysteroscopy guided by B-ultrasonography.Methods A total of 102 patients with submucous uterine fibroids treated by B-ultrasound-guided hysteroscopic surgery in Chenghua District Maternal and Child Health Hospital,Huai'an Fifth People's Hospital and Susong County People's Hospital from March 2019 to January 2022 were enrolled in this study and divided into two groups by random number table method.The patients in the control group(n=51)received vitamin D treatment and those in the observation group(n=51)received vitamin D combined with triprorelin after B-ultrasound-guided hysteroscopic surgery.The data of efficacy,changes of sex hormone indexes before and after treatment,changes of endometrial thickness,endometrial resistance index,normal rate of uterine volume and normal rate of menses 6 months after surgery,and recurrence rate 6 months after surgery were compared between the two groups.Results The curative effect of the observation group was better than that of the control(96.08%(49/51)vs 84.31%(43/51),χ^(2)=3.991,P<0.05).After treatment,the sex hormone indexes of follicle stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)in the observation group were(5.25±0.28)IU·L^(-1),(7.97±0.48)IU·L^(-1),(95.23±5.23)ng·L^(-1),respectively.They were all lower than those in the control group((6.50±0.37)IU·L^(-1),(9.38±0.58)IU·L^(-1),(111.52±6.23)ng·L^(-1))(t=19.239,13.375,14.302,all P<0.05).After treatment,the endometrial resistance index of the observation group was lower than that of the control((0.42±0.08)%vs(0.66±0.10)%,t=13.384,P<0.05),and the endometrial thickness was higher than that of the control((8.73±0.31)mm vs(5.34±0.26)mm,t=59.836,P<0.05).Six months after surgery,the normal rate of uterine volume (92.16%(47/51) vs 76.47%(39/51), χ^(2)=4.744, P<0.05) and normal rate of menstruation (94.12%(48/51) vs 80.39%(41/51), χ^(2)=4.320, P<0.05) in the observation group were both higher than those in the control group. Meanwhile, the recurrence rate 6 months after surgery and 1 year after surgery in the observation group were both lower than those in the control ( χ^(2)=4.163, 6.375, both P<0.05). Conclusion Triprerelin combined with vitamin D has a good effect on preventing the recurrence of submucosal uterine fibroids after hysteroscopy guided by B-ultrasonography since it can better improve the level of sex hormones and endometrial conditions of patients and promote the return of uterine volume and menses to normal.