手術(shù)前應(yīng)用GnRH—a治療子宮腺肌病的臨床療效研究

黃劍雄　李勵(lì)軍　池慧娟

【摘要】 目的：探討行全子宮切除術(shù)術(shù)前應(yīng)用促性腺激素釋放激素激動(dòng)劑（GnRH-a）治療子宮腺肌病的臨床應(yīng)用價(jià)值。方法：選取2014年1月-2016年8月莆田學(xué)院附屬醫(yī)院行腹腔鏡全子宮切除的子宮腺肌病患者65例，按照隨機(jī)數(shù)字表法分為治療組30例和對(duì)照組35例。治療組術(shù)前予皮下注射GnRH-a兩個(gè)周期后再行手術(shù)，對(duì)照組直接手術(shù)，比較兩組患者的手術(shù)時(shí)間、術(shù)中出血量、中轉(zhuǎn)開(kāi)腹率、術(shù)后病率、住院天數(shù)等指標(biāo)。結(jié)果：治療組患者術(shù)前血紅蛋白含量、子宮最大徑及CA125水平均優(yōu)于注射GnRH-a前，比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組患者手術(shù)時(shí)間、術(shù)中出血量、中轉(zhuǎn)開(kāi)腹率、術(shù)后病率、住院天數(shù)幾個(gè)均優(yōu)于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：子宮腺肌病行子宮切除術(shù)前使用GnRH-a預(yù)處理具有出血少、住院時(shí)間短、恢復(fù)快等優(yōu)點(diǎn)，在嚴(yán)格掌握手術(shù)適應(yīng)證情況下，值得臨床推廣。

【關(guān)鍵詞】 子宮腺肌病； 促性腺素釋放激素； 子宮切除術(shù)；

【Abstract】 Objective：To investigate the clinical value of gonadotropin releasing hormone agonist（GnRH-a） in the treatment of adenomyosis before total hysterectomy. Method：From January 2014 to August 2016，65 patients with adenomyosis who underwent laparoscopic hysterectomy in Affiliated Hospital of Putian College were collected，and divided into treatment group（30 patients） and control group（35 patients）.The treatment group was treated with 2 cycles subcutaneous injection GnRH-a before operation，while control group direct received operation.The operation time， intraoperative blood loss volume，conversion to laparotomy rate，postoperative morbidity and hospital stays of two groups were compared.Result：The hemoglobin content，the maximum diameter and CA125 level of treatment group after injected GnRH-a were better than those before，the differences were statistically significant（P<0.05）.Operation time，intraoperative blood loss，conversion to laparotomy， postoperative morbidity and hospitalization stays of treatment group were better than those of the control group，the differences were statistically significant（P<0.05）.Conclusion：GnRH-a pretreatment before hysterectomy for adenomyosis has advantages like less bleeding，shorter hospital stays，faster recovery，which worthy of clinical promotion after mastery the hysterectomy indication.

【Key words】 Adenomyosis； Gonadotropin-releasing hormone； Hysterectomy

First-authors address：Affiliated Hospital of Putian College，Putian 351100，China

doi：10.3969/j.issn.1674-4985.2017.25.010

子宮腺肌病是一種嚴(yán)重影響婦女健康和生活的婦科常見(jiàn)病，國(guó)內(nèi)外學(xué)者研究發(fā)現(xiàn)其發(fā)病率在5%～70%[1-2]。子宮腺肌病的發(fā)病年齡常在35～50歲，也可以發(fā)生在年輕女性[3]。子宮腺肌病臨床癥狀常以繼發(fā)性進(jìn)行性痛經(jīng)、經(jīng)量過(guò)多、不規(guī)則陰道出血、慢性盆腔疼痛等為主要表現(xiàn)，部分患者可導(dǎo)致嚴(yán)重貧血。治療子宮腺肌病包括藥物治療（孕激素、GnRH-a、抗雌激素、口服避孕藥）、輔助生殖技術(shù)治療[促排卵/人工授精（COH/IUI），體外授精-胚胎移植（IVF-ET）]、介入治療[放射、超聲、高強(qiáng)度聚焦超聲（HIFU）]以及手術(shù)治療（首選腹腔鏡）等[4-7]。保守治療無(wú)效、癥狀較為嚴(yán)重的、年齡較大的患者常選擇子宮切除術(shù)。因其可合并子宮內(nèi)膜異位癥導(dǎo)致增生、浸潤(rùn)、轉(zhuǎn)移等行為，引起盆腔廣泛的粘連，一定程度增加手術(shù)難度。因此，如何降低手術(shù)難度、減少術(shù)中、術(shù)后并發(fā)癥也成為學(xué)者們探索的目標(biāo)。……