宫腔镜下电切术联合GnRH-a在子宫黏膜下肌瘤异常子宫出血患者中的研究  

Application of hysteroscopic electrotomy combined with GnRH-a in patients with submucosal myoma abnormal uterine bleeding

作　　者：吴利萍[1] 侯伟涛 牛三强 郭慧娟 杜宁宁[1] WU Liping;HOU Weitao;NIU Sanqiang;GUO Huijuan;DU Ningning(Department of Obstetrics and Gynecology,Bozhou City People′s Hospital,Bozhou 236800,Anhui,China)

机构地区：[1]亳州市人民医院妇产科,安徽亳州236800

出　　处：《中国性科学》2021年第2期92-96,共5页Chinese Journal of Human Sexuality

摘　　要：目的探讨促性腺激素释放激素类似物(GnRH-a)联合宫腔镜下电切术在子宫黏膜下肌瘤异常子宫出血患者中的应用效果。方法选取2017年2月至2019年7月亳州市人民医院收治的102例子宫黏膜下肌瘤异常子宫出血患者作为研究对象。对其临床资料进行回顾性分析。将术前实施GnRH-a预处理的患者记为A组(n=39),术前实施孕三烯酮预处理患者记为B组(n=32),术前未实施预处理患者记为C组(n=31)。比较三组预处理前后手术指标,术后3个月月经改善情况,术后并发症、6个月内复发率和有生育需求者妊娠成功率。结果三组术中膨宫液使用量、手术时间、出血量、术后月经来潮时间、术后3个月月经改善情况和改善率、术后并发症发生率均相近,差异无统计学意义(P>0.05);三组膨宫液吸收量比较,差异具有统计学意义(P<0.05),且C组最多,B组次之,A组最少;A组黏膜切净率明显高于B组、C组,差异具有统计学意义(P<0.05);C组术后复发率远高于A组,差异具有统计学意义(P<0.01);B组和C组有生育需求者妊娠成功率均远低于A组,差异具有统计学意义(P<0.01)。结论在子宫黏膜下肌瘤异常子宫出血患者中应用GnRH-a联合宫腔镜下电切术治疗能够明显缩小肌瘤体积,减少术中膨宫液吸收量,降低术中黏膜残留风险,控制复发,提高有生育需求者妊娠成功率,且效果明显优于孕三烯酮预处理和未预处理者。Objective To investigate the effect of gonadotropin-releasing hormone analogue(GnRH-a)combined with hysteroscopic electrotomy in patients with submucosal myoma abnormal uterine bleeding.Methods 102 patients with submucosal fibroids abnormal uterine bleeding treated in Bozhou City People′s Hospital from February 2017 to July 2019 were selected as the research subjects,and their clinical data were retrospectively analyzed.Patients pretreated with GnRH-a were classified as group A(n=39),patients pretreated with gestrinone as group B(n=32),and patients without any pretreating as group C(n=31).The surgical indicators before and after pretreating,menstrual improvement at 3 months after surgery,postoperative complications,recurrence rate within 6 months and pregnancy success rate of women with fertility needs were compared between the three groups.Results The amount of uterine dilatation fluid used during operation,operative time,bleeding volume,menstruation time after operation,menstrual improvement and improvement rates at 3 months after operation,and incidence of postoperative complications in the three groups were similar(P>0.05).There was a significant difference in the absorption of uterine dilatation fluid among the three groups(P<0.05),and the most in group C,followed by group B and the least in group A.The mucosal clearance rate in group A was significantly higher than that in group B and C(P<0.05).The postoperative recurrence rate of group C was significantly higher than that of group A(P<0.01).The success rate of pregnancy of patients with fertility demand in group B and group C was significantly lower than that in group A(P<0.01).Conclusions GnRH-a combined with hysteroscopic electrotomy in the treatment of submucosal myoma abnormal uterine bleeding can significantly reduce the volume of fibroids,the absorption of uterine dilatation fluid,and the risk of mucosal residual,control recurrence,and improve the pregnancy success rate of those with fertility needs,and the effect is significantly better than that

关 键 词：促性腺激素释放激素类似物 宫腔镜 电切术 子宫黏膜下肌瘤 异常子宫出血 

分 类 号：R711[医药卫生—妇产科学]