他莫昔芬联合亮丙瑞林预处理应用于巨大子宫肌瘤患者LSHM的临床效果

Clinical effect of tamoxifen combined with leprerelin pretreatment on LSHM in patients with giant uterine fibroids

目的观察他莫昔芬联合亮丙瑞林预处理应用于巨大子宫肌瘤患者腹腔镜子宫肌瘤剔除术(LSHM)的临床效果。方法选取2021年2月—2023年2月于厦门大学附属第一医院杏林分院行LSHM治疗的巨大子宫肌瘤患者156例,根据随机数字表法分为联合他莫昔芬组和单用亮丙瑞林组,各78例。联合他莫昔芬组术前予他莫昔芬联合亮丙瑞林治疗,单用亮丙瑞林组术前予亮丙瑞林治疗。比较2组围术期指标、卵巢储备功能、子宫与肌瘤体积、生长因子水平、术后随访1年的复发率及妊娠率。结果联合他莫昔芬组手术时间、术中出血量、术后排气时间及盆腔引流量均短/少于单用亮丙瑞林组(P<0.01)。术前,2组黄体生成素、卵泡刺激素、雌二醇水平,子宫体积、肌瘤体积,转化生长因子-β1、表皮生长因子、缺氧诱导因子-1α水平均低于预处理前,且联合他莫昔芬组低于单用亮丙瑞林组(P<0.05或P<0.01)。术后随访1年,联合他莫昔芬组复发率为1.32%,低于单用亮丙瑞林组的10.67%(χ^(2)=4.339,P=0.037);联合他莫昔芬组妊娠率为28.89%,高于单用亮丙瑞林组的10.26%(χ^(2)=4.493,P=0.034)。结论与单用亮丙瑞林相比,联合他莫昔芬LSHM术前预处理可进一步缩短巨大子宫肌瘤患者的手术时间与术后排气时间,减少术中出血量、盆腔引流量,缩小子宫和肌瘤体积的效果更佳,可进一步改善卵巢储备功能,有效抑制生长因子表达,降低肌瘤复发率,提高患者妊娠率。

Objective To observe the clinical effect of tamoxifen combined with leprerelin pretreatment on LSHM in patients with giant uterine fibroids.Methods A total of 156 patients with giant uterine fibroids who underwent LSHM in Xinglin Branch of the First Affiliated Hospital of Xiamen University from February 2021 to February 2023 were selected and randomly divided into tamoxifen combined group and leprerelin alone group according to the random number table method,with 78 cases in each group.The tamoxifen combined group was treated with tamoxifen plus leprerelin preoperatively,and the leprerelin alone group was treated with leprerelin preoperatively.The perioperative indicators,ovarian reserve function,uterine and fibroid volume,growth factor level,recurrence rate and pregnancy rate after 1-year follow-up were compared between the two groups.Results The operation time,intraoperative blood loss,postoperative exhaust time and pelvic drainage volume in the tamoxifen combined group were shorter/less than those in the leprerelin alone group(P<0.01).Before operation,the levels of LH,FSH,E 2,uterine volume,fibroid volume,TGF-β1,EGF,HIF-1αin the two groups were better than those before pretreatment,and the tamoxifen combined group was better than leprerelin alone group(P<0.05 or P<0.01).After 1-year follow-up,the recurrence rate in the tamoxifen combined group was 1.32%,which was lower than 10.67%in the leprerelin alone group(χ^(2)=4.339,P=0.037).The pregnancy rate of tamoxifen combined group was 28.89%,which was higher than 10.26%of leprerelin alone group(χ^(2)=4.493,P=0.034).Conclusion Compared with leprerelin alone,LSHM preoperative pretreatment with tamoxifen can further shorten the operation time and postoperative exhaust time of patients with giant uterine fibroids,reduce intraoperative blood loss,pelvic drainage volume,and reduce the volume of uterus and fibroids.It can further improve ovarian reserve function,effectively inhibit the expression of growth factors,reduce the recurrence rate of fibroids,and improve the pregnancy rate of patients.