GnRHa预治疗时间对腹腔镜下子宫肌瘤剔除术的影响

目的探讨不同预治疗时间对腹腔镜下子宫肌瘤剔除术手术过程及效果的影响。方法2008年1月至2010年12月期间经GnRHa预治疗后实施腹腔镜下子宫肌瘤剔除术的患者42例，分为A组（18例，术前GnRHa预治疗两个月）和B组（24例，术前GnRHa预治疗3个月）。观察并比较两组患者用药前后子宫及肌瘤体积变化、手术情况、术后随访情况等。结果两组患者用药前子宫体积、最大肌瘤体积比较无统计学差异（P〉0．05），手术前均有显著缩小（P〈O．05）。B组患者缩小幅度更大（P〈0．05）。两组患者手术时间、术中出血量、缝合例数等情况的比较无统计学差异（P〉0．05）。A组患者没有副作用出现，B组患者有7例（29．2％）副作用出现，两组患者间比较有统计学差异（X2=4．38，P〈0．05）。两组患者术后两年内各有1例子宫肌瘤复发，两组间比较无统计学差异（x2=0．27，P〉o．05）。A组12例备孕患者中有6例妊娠；B组15例备孕患者中有7倒妊娠，两组间妊娠率的比较无统计学差异（x2=0．03，P〉0．05）。结论术前使用GnRHa预处理两个月，子宫及肌瘤体积缩小程度不及使用3个月者显著．但不影响手术操作与效果。

The Influence of Different Pretreatment Time with GnRHa on Laparoscopic Myomectomy

Objective To evaluate the influence of different pretreatment time with GnRHa on the process and effect of laparoscopic myomectomy. Methods Forty-two patients undergoing laparoscopic myomectomy after pretreatment with GnRHa from Jan 2008 to Dec 2010 were retrospectively analyzed and grouped into Group A （18 patients pretreated with GnRHa for 2 months ） or Group B （24 patients pretreated for 3 months）. The changes of uterine and myoma sizes, the indexes about surgery operation, the surgical outcomes in a two-year postoperative follow up were compared between the two groups. Results Patients in both groups showed contracted uterine and myoma after GnRHa pretreatment, while the contracted degrees were much more higher in Group B （P 〈0.05）. No difference was found between the two groups in operation time, blood loss and proportions of suture （P 〉0.05）. No GnRHa related side effect was found in Group A, while 7 cases （29.2%） was found in Group B （x2 = 4.38, P〈0.05）. No difference was found in the rate of myoma relapse （1 case, 5.56%） in Group A vs 1 case （4.17%） in Group B, （X2 = 0.27, P〉0.05 ） and the rate of pregnancy （6/12, 50.0%） in Group A vs 7/15 （46.7%） in Group B, X2 = 0.03, P 〉0.05）. Conclusions 2-month pretreatment results in less volume reduction of uterine and myoma than 3-month pretreatment, but doesn＇t impact the surgical operation and its effect.