促性腺激素释放激素激动剂治疗子宫肌瘤临床疗效观察

促性腺激素释放激素激动剂治疗子宫肌瘤临床疗效观察

吕  华¹  夏恩兰²  成九梅²  彭雷冰²  (1  北京市海淀医院  100080；2  首都医科大学附属北京复兴医院  100038)

Observation of effects of gonadotrophin releasing hormoneAgonist in the treatment of uterine leiomyoma  LU Hua*，XIA Enlan,CHENG Jiumei,et al  (*Department of Obstetrisc and Gynecology,Beijing Haidian Hospital, Beijing 100080,China)

　　Abstract  Objective  To investigate clinical effects of gonadotrophin releasing hormone agonist (GnRHa)in the treatment of uterine leiomyoma.Methods  30patients of uterine leiomyoma in the study group were treated by GnR-Ha for 2 to 4 months.Uterine and uterine leiomyoma volume were measured by transvaginal ultrasonography before and after treatment. Sex hormonal parameters were also measured at the same time.Opreations were performed at 4 to 6 weeks after the last injection of GnRHa.30 patients of control group were performed operations at the same time of the GnRHa group. Results  The decrease of uterine and uterine leiomoma volume was statistically significant(P＜0.01).The shrinkage rate of uterine volume and uterine leiomyoma was 42.77±12.11% and 37.65±15.20% respective-ly.Pre-and post-treatment serum sexhormonal parameter was significantly reduced(P＜0.01).Histopathological exam-ination showed that uterine leiomyoma exhibited more hyalinization,greater cell density,slightly smaller cell sizes and larger collagen fibrils,but no significantly different compared with the control group(P＞0.05).Conclusions  GnRHa was an effective drug of treatment of uterine leiomyoma.

　　Key words  Gonadtrophin releasing hormone agonist;Uterine leiomyoma

1  资料与方法

1.1  资料

1.1.1 试验组  30例选自2002年5月至2003年10月在首都医科大学附属北京复兴医院宫腔镜中心就诊的子宫肌瘤患者，年龄24～53岁，平均(38.67±6.04)岁。病程3～120个月，平均(30.03±20.34)个月。近3个月未经任何内分泌治疗，肝肾功正常。于末次应用GnRHa 4～6周后手术。手术方式：宫腔镜子宫肌瘤切除术17例,腹腔镜子宫肌瘤剔除术6例，腹腔镜辅助阴式子宫切除术2例，经腹子宫肌瘤剔除术3例，腹腔镜全子宫切除术2例。

1.1.2 对照组  30例为与试验组同期手术的子宫肌瘤患者，年龄23～53岁，平均(39.30±6.05)岁。病程2～120个月，平均(30.70±20.07)个月。手术方式：宫腔镜子宫肌瘤切除术18例，腹腔镜子宫肌瘤剔除术7例，腹腔镜辅助阴式子宫切除术2例，经腹子宫肌瘤剔除术2例，腹腔镜全子宫切除术1例。其余条件同试验组。

1.2  方法

1.2.1 GnRHa用法  GnRHa用达菲林(法国博福-益普生公司)，有效化学成分曲普瑞林醋酸盐。取臀部外上四分之一处深部肌肉注射，3.75mg/28d，共注射2～4次。

1.2.2 血性激素测定  测定雌二醇(E2)、孕酮(P)、促卵泡激素(FSH)、促黄体生成素(LH)及催乳素(PRL)水平。

1.2.3 子宫体积测定  试验组于肌注GnRHa前1天及手术前1天分别阴道超声测量子宫及肌瘤的三维径线(用a.b.c分别代表)，按椭圆球体计算，体积(cm3)=0.523×a×b×c。多发肌瘤计算总体积。体积缩小百分比=［(V_用GnRHa前-V_用GnRHa后)/V_用GnRHa前］×100%。对照组于手术前1天作上述测量工作。

1.2.4　观察试验组的副反应情况  自应用GnRHa后嘱患者记录有否潮热、烦躁、头晕、阴道干涩、性欲减退、失眠、脱发及骨关节疼痛等情况，并记录出现的时间及强度，用否雌、孕激素反相添加等情况。

1.3 统计学方法  用SPSS10.0软件进行数据处理。

2  结果

2.1 应用GnRHa前后子宫及肌瘤体积情况(表1)  应用GnRHa 2～4个月后，子宫肌瘤及子宫体积均明显缩小。

2.2 应用GnRHa前后血性激素情况(表2)  可见，GnRHa明显降低血性激素水平，尤其以E₂下降最为显著，最大下降率为65.26%。