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目的分析腹腔镜下子宫肌瘤剔除术联合术前应用促性腺激素释放激素激动剂(Gn RH-a)治疗子宫体积>孕12周子宫肌瘤的治疗效果。方法选取该院2009年8月-2016年8月收治的子宫体积>孕12周的46例子宫肌瘤患者作为研究对象,术前给予亮丙瑞林皮下注射3~6针,治疗后1个月行腹腔镜下子宫肌瘤剔除术。观察药物治疗前后子宫及肌瘤体积的变化、血红蛋白的变化、肌瘤相关症状的变化、用药后的副反应、术中出血量、手术时间、住院时间、术后有无并发症和随访术后肌瘤是否复发等情况。结果 46例患者在Gn RH-a治疗前B超检查测定子宫平均体积(705.47±282.37)cm~3,治疗后平均体积(331.95±84.53)cm~3,缩小59.35%,差异有统计学意义(P<0.05)。Gn RH-a治疗前B超检查测定子宫肌瘤平均体积(237.59±138.46)cm~3,治疗后平均体积(81.59±46.44)cm~3,缩小65.66%,差异有统计学意义(P<0.05)。Gn RH-a治疗前血红蛋白值为(97.80±20.19)g/L,治疗后血红蛋白值为(119.63±12.06)g/L,差异有统计学意义(P<0.05)。所有手术均顺利完成,无1例中转开腹。术后随访时间3个月~5年,均恢复良好,无明显手术并发症。结论术前应用Gn RH-a治疗子宫肌瘤,可以显著缩小肌瘤体积、提高患者血红蛋白水平,从而使子宫体积>孕12周的肌瘤患者能够完成保留子宫的微创手术。
Objective To analyze the therapeutic effect of laparoscopic myomectomy combined with preoperative GnRH agonist (Gn RH-a) on uterine volume> 12 weeks uterine myoma. Methods Forty-six patients with uterine fibroids who were treated in our hospital from August 2009 to August 2016 were enrolled in this study. 46 cases of uterine leiomyoma were enrolled in this study. Month line laparoscopic myomectomy. The change of uterine and fibroid volume, the change of hemoglobin, the change of fibroid related symptoms, the side effects after treatment, the amount of bleeding during operation, the operation time, the length of hospital stay, the complications after operation and the follow-up after operation were observed Whether recurrence of fibroids and so on. Results The average volume of uterus (705.47 ± 282.37) cm ~ 3 and the average volume after treatment (331.95 ± 84.53) cm ~ 3 were reduced by 59.35% in 46 patients before Gn RH-a treatment, the difference was statistically significant P <0.05). The average volume of uterine myoma (237.59 ± 138.46) cm ~ 3 after treatment with Gn RH-a before treatment was 81.59 ± 46.44 cm ~ 3 and the reduction was 65.66% (P <0.05) ). The hemoglobin value of Gn RH-a before treatment was (97.80 ± 20.19) g / L, and the hemoglobin value after treatment was (119.63 ± 12.06) g / L, with statistical significance (P <0.05). All operations were successfully completed, no case of conversion to laparotomy. The follow-up time ranged from 3 months to 5 years, with good recovery and no obvious complications. Conclusion Gn RH-a preoperative treatment of uterine fibroids, can significantly reduce the size of fibroids and improve patient hemoglobin levels, so that uterine volume> 12 weeks of fibroids patients to complete the minimally invasive surgery to retain the uterus.