缩宫素预处理在宫腔镜电切治疗黏膜下子宫肌瘤中的临床研究

目的 探讨采用宫腔镜经宫颈子宫肌瘤切除术（TCRM）前进行缩宫素预处理的可行性及应用价值.方法 选择2005年2月至2009年10月在本院妇产科诊断为黏膜下子宫肌瘤并接受宫腔镜TCRM的患者共计122例为研究对象.按照采用宫腔镜TCRM前是否采用缩宫素预处理将其分为预处理组（n=60,采用缩宫素预处理）与对照组（n=62,未予缩宫素预处理）.预处理组术前肌内注射缩宫素3 d后再行TCRM,对照组则直接行TCRM.采用统计学方法分析两组手术时间、术中出血量、液体吸收量及术后住院天数等,并随访研究两组患者的症状改善及术后妊娠情况（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书）.两组患者平均年龄、中至重度贫血发生率、不良孕产史发生率及一般临床症状程度等比较,差异无统计学意义（P〉0.05）.结果 与对照组比较,预处理组术前经缩宫素处理后可缩短平均手术时间,减少液体吸收量及术中出血量,缩短术后住院天数,两组比较,差异有统计学意义（P〈0.05）;对两组患者随访（22.35±1.34）个月时,其月经量改变及不规则阴道流血症状改善率、术后妊娠率比较,差异无统计学意义（P〉0.05）,但缩宫素预处理组残余肌瘤的复发率较对照组显著降低,差异无统计学意义（P〈0.05）.结论 TCRM前应用缩宫素预处理可缩短手术时间、减少术中出血量及术中液体吸收量,并可降低残余肌瘤的复发率,但是否值得临床推广应用,尚需多中心、大样本的随机对照研究进一步证实.

Clinical Studies of Oxytocin Pretreatment in Treatment of Submucosal Uterine Fibroids by Hysteroscopic Transurethral Resection

Objective To explore the feasibility and value of oxytocin pretreatment in the treatment of submucosal uterine fibroids by use of hysteroscopic transcervical resection of myoma （TCRM）. Methods From February 2005 to October 2009, a total of 122 cases of patients with submucosal uterine fibroids undergoing hysteroscopic TCRM were included in this study. According to whether oxytocin pretreatment before TCRM or not, they were divided into oxytocin pretreatment group（n ~ 60, oxytocin pretreatment before TCRM） and control group （n~ 62, did not pretreatment by oxytocin before TCRM）. Electrocision was underwent 3 days after intramuscular injection of oxytocin for oxytocin pretreatment group, however electrocision was underwent directly for control group. Average duration of operation, intraoperative blood loss volume, liquosorption volume and postoperative hospitalization time between two groups were analyzed by statistical method. Then postoperative improvement of symptoms and pregnancy were followed up and analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Wendeng Central Hospital of Weifang Medical College. Informed consent was obtained from all participants. There had no significance difference between two groups among average age, incidence rate of moderate to severe anemia and adverse pregnancy history and general degree of clinical symptoms（P〈0.05）. Results There had significance difference between two groups among average duration of operation, intraoperative blood loss volume, liquosorption volume and postoperative hospitalization time （P〈0.05）. After following up for （22.35±1.34） months, there had no significance difference between two groups in respect of changes of menstrual volume, improvement of irregular vaginal bleeding symptom and pregnancy rates （P 〈 0. 05）, but recurrence rates of residual fibroids in oxytocin pretreatment group were reduced much more than those in control group（P〈0.05）. Conclusions Applying oxytocin pretreatment before use of hysteroscopic TCRM may shorten average duration of operation and postoperative hospitalization time, decrease blood loss volume and liquosorption volume, reduce the recurrence rates of residual fibroids.