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目的评价术前使用促性腺激素释放激素激动剂(gonadotropin releasing hormone agonists,GnRHa)对子宫体积≥孕12周的子宫腺肌病患者腹腔镜微创手术的影响及GnRHa联合腹腔镜对子宫腺肌病的治疗疗效。方法收集2011年1月至2015年1月青岛市立医院收治的子宫体积≥孕12周的子宫腺肌病患者34例的临床资料。术前予GnRHa(戈舍瑞林)皮下注射2~3针(1针/28 d),停药15~30 d综合评估后进行腹腔镜子宫腺肌病病灶切除术。记录药物治疗前后的子宫腺肌瘤体积、血红蛋白水平、血清(cancer antigen 125,CA 125)水平及手术完成情况。术后自愿接受GnRHa继续治疗的18例患者为研究组,未接受GnRHa继续治疗的16例患者为对照组。术后3、6、9、12月监测痛经程度、月经量、子宫体积、血清CA 125水平、血红蛋白水平及围绝经期症状发生情况。结果 34例患者术前在GnRHa治疗后腺肌瘤体积明显缩小(P<0.05),血红蛋白水平明显升高(P<0.05),CA 125水平显著下降(P<0.05)。所有患者均采用腹腔镜完成手术,无中转开腹者。术后研究组和对照组的经量过多及痛经改善情况在随访12月时、子宫体积在随访9、12月时、CA 125水平在随访6月时出现明显变化,差异有统计学意义(P<0.05);两组血红蛋白水平比较差异无统计学意义(P>0.05)。治疗过程中,需反向添加治疗患者11例,添加治疗后,潮热出汗、骨关节痛等围绝经期症状均得到不同程度的改善。结论在子宫体积≥孕12周的子宫腺肌病患者中,术前使用2~3月戈舍瑞林可以显著提高血红蛋白水平,缩小腺肌瘤体积,有利于腹腔镜手术的顺利进行;手术前后连续使用GnRHa较单纯术前用药可获得更好的疗效,推迟疾病的复发,值得临床推广。
Objective To evaluate the effect of preoperative gonadotropin releasing hormone agonists (GnRHa) on laparoscopic minimally invasive surgery in patients with uterine adenomyosis at the gestational age ≥ 12 weeks and GnRHa combined with laparoscopy on adenomyosis Therapeutic efficacy. Methods The clinical data of 34 patients with uterine adenomyosis who were ≥ 12 weeks of pregnancy in Qingdao Municipal Hospital from January 2011 to January 2015 were collected. Preoperative GnRHa (goserelin) subcutaneous injection of 2 to 3-pin (1 needle / 28 d), withdrawal 15 to 30 d after a comprehensive assessment of laparoscopic adenomyosis resection. The volume of adenomyoma, the level of hemoglobin, the level of serum antigen (CA125) and the completion of surgery before and after the drug treatment were recorded. Eighteen patients who voluntarily received GnRHa follow-up after operation were study group, and 16 patients who did not receive GnRHa treatment were control group. Dysmenorrhea, menstrual flow, uterine volume, serum CA 125 level, hemoglobin level and perimenopausal symptoms were monitored at 3, 6, 9 and 12 months after operation. Results The volume of adenomyoma was significantly decreased (P <0.05), the hemoglobin level was significantly increased (P <0.05) and the CA 125 level was significantly decreased in 34 patients before GnRHa treatment (P <0.05). All patients were laparoscopic surgery, no transfer of open surgery. Postmenopausal study group and control group were over-dose and improvement of dysmenorrhea at the follow-up of 12 months, uterine volume at follow-up 9,12 months, CA 125 levels at follow-up of 6 months showed significant changes, the difference was statistically significant ( P <0.05). There was no significant difference in hemoglobin level between the two groups (P> 0.05). Treatment process, the need to reverse the treatment of patients added 11 cases, add the treatment, hot flashes, joint pain and other perimenopausal symptoms have been improved to varying degrees. Conclusion In patients with uterine adenomyosis ≥ 12 weeks of pregnancy, preoperative use of 2 to 3 months of goserelin can significantly increase hemoglobin levels, reduce the size of adenomyosis, which is conducive to the success of laparoscopic surgery; before and after surgery Continuous use of GnRHa than simple preoperative medication can get better efficacy, delay the recurrence of the disease, it is worth clinical promotion.