GnRHa对育龄期女性Ⅱ型黏膜下子宫肌瘤电切术后宫腔粘连及妊娠结局的影响  

Effect of GnRHa on intrauterine adhesions and pregnancy outcomes in women of childbearing age with type Ⅱ submucous uterine myoma after electrotomy

作　　者：申丽媛 池余刚[1] 杨晓煜[1] 彭书敏 文亚玲[1] Shen Liyuan;Chi Yugang;Yang Xiaoyu;Peng Shumin;Wen Yaling(Department of Gynecology,Chongqing Health Center for Women and Children)

机构地区：[1]重庆市妇幼保健院妇科

出　　处：《重庆医科大学学报》2019年第8期1094-1097,共4页Journal of Chongqing Medical University

基　　金：重庆市卫计委医学科研资助项目（编号：2015ZBXM029）

摘　　要：目的:探讨GnRHa对有生育要求的育龄期女性Ⅱ型黏膜下子宫肌瘤电切术后宫腔粘连及妊娠结局的影响。方法:收集2015年5月至2017年5月在我院诊断为Ⅱ型黏膜下子宫肌瘤并行宫腔镜下子宫肌瘤切除术的患者58例,根据术前是否使用促性腺激素释放激素激动剂(GnRHa),分为GnRHa组(A组)和非GnRHa组(B组),GnRHa组(A组)术前应用GnRHa3个周期后行宫腔镜切除Ⅱ型黏膜下子宫肌瘤30例,非GnRHa组(B组)术前不应用GnRHa,直接行宫腔镜切除黏膜下肌瘤28例,记录手术时间、术中出血量、膨宫液体量,1个月后再次行宫腔镜检查,评估宫腔情况,记录宫腔粘连发生情况,同时取部分子宫内膜组织,通过免疫组化检测Ⅰ型胶原蛋白(collagenⅠ,Col-Ⅰ)、结缔组织生长因子(connective tissue growth factor,CTGF)和转化生长因子-β1(tansforming growth factor-β1,TGF-β1)在2组中的表达情况,尝试妊娠6~12个月随访妊娠结局。结果:(1)A组患者平均手术时间为(40.90±15.09)min,B组为(52.9±13.5)min,A组术中平均出血量为(27.0±14.4)mL,B组为(52.3±17.5)m L,两者比较差异均有统计学意义(P<0.05)。(2)宫腔镜电切术后A组宫腔粘连发生率为6.7%(2/30),B组为7.7%(2/26),2组无统计学差异(P>0.05)。(3)2组中Col-Ⅰ、CTGF及TGF-β1的表达差异无统计学意义(P>0.05)。(4)尝试妊娠后随访6~12个月,A组妊娠率达72%,B组妊娠率达68.2%,2组无统计学差异(P>0.05)。结论:GnRHa预处理明显缩短手术时间及术中出血量,但未能改善术后宫腔粘连的发生及患者的妊娠情况。Objective:To investigate the effect of GnRHa on intrauterine adhesions and pregnancy outcomes in women of childbearing age with type Ⅱ submucous uterine myoma after electrotomy. Methods:Fifty-eight patients were enrolled in the study who were diagnosed with type Ⅱ submucosal uterine myoma and underwent hysteroscopic resection in our hospital from May 2015 to May 2017.According to whether GnRHa was used or not before the operation,these patients were divided into GnRHa group(A group)and nonGnRHa group(B group). In the A group,all 30 cases received hysteroscopic resection after three cycles of GnRHa treatment,while in the B group,all 28 cases received the same surgery without GnRHa treatment. The operation time,intraoperative blood loss,and distention volume were recorded in both groups. Hysteroscopy was performed again one month later to evaluate the condition of uterine cavity and record the occurrence of intrauterine adhesions. Some endometrial tissues were then collected,and immunohistochemistry was used to determine the expression of collagen typeⅠ(Col-Ⅰ),connective tissue growth factor(CTGF),and transforming growth factor-β1(TGF-β1). The pregnancy outcome was followed up for 6 to 12 months after attempted pregnancy. Results:The mean time of operation in the A group and B group was(40.90±15.09)min and 52.9±13.5 min,respectively,and the mean intraoperative blood loss in both groups was(27.0±14.4)mL and(52.3±17. 5) mL,respectively. There were significant differences between these two groups regarding the time of operation and intraoperative blood loss(P<0.05). The incidence rate of intrauterine adhesions was6.7%(2/30)in the A group and 7.7%(2/26)in the B group after hysteroscopic resection,showing no significant difference between these two groups(P>0.05). There were no significant differences in the expression of Col-Ⅰ,CTGF,and TGF-β1 between the two groups(P>0.05). All cases were followed up for 6 to 12 months after attempted pregnancy,and the postoperative pregnancy rate was 72% in the A grou

关 键 词：GNRHA Ⅱ型黏膜下子宫肌瘤 宫腔粘连 Ⅰ型胶原蛋白 转化生长因子-β1 结缔组织生长因子 

分 类 号：R713.4[医药卫生—妇产科学]