The Applicationg And Value Of Mifepristone On Multiple Uterine Leiomyomas After Hysteromyomectomy

Objective1. Through the research on influence of mifepristone to sex hormones after hysteromyomectomy to explore the possible mechanism that mifepristone can inhibit the regeneration of multiple uterine leiomyomas.2. Through the test on the expression of estrogen receptor and progesterone receptor in uterine leiomyoma organization to discuss their relationship with uterine leiomyoma, to look for the the theory basis of taking mifepristone.3. Discussing the feasibility that taking mifepristone can prevent the recurrence of multiple uterine leiomyomas after hysteromyomectomy.Methods1. Collecting thirty-six cases of patients with multiple uterine leiomyomas who had received hysteromyomectomy in Jinan Military General Hospital from July 2009 to January 2010. All of the patients are proved to have multiple uterine leiomyomas by pelvic examination, B ultrasound, what we had seen in Surgery, and the later pathology, the tissue pathology diagnosis is the final diagnosis. Operation time selection in follicular phase is seventeen cases and nineteen cases in luteal phase. None of these patients has endocrinic disease, or use any hormone drugs before surgery.When patients can eat liquid diet after hysteromyomectomy, tell them to take ten milligram mifepristone once a night until three months. Extracting 5ml peripheral venous blood before surgery, when a week after surgery, three months after surgery, and three months after stopping taking drugs, then, to determine the numerical of estrogen, progesterone, follicle stimulating hormone, luteinizing hormone by electrochemical luminescence immunoassay analysis. Do self-reflection by comparing postoperative and preoperative results. Recording discomfort reaction after the patients taking mifepristone and the time when menstruation reback, the menstrual quantity, menstrual cycle etc, after stopping taking drugs. To observe the recurrence rate of uterine leiomyomas one year, to detect liver function, kidney function, blood sugar, blood fat, adrenal cortical hormone of patients before surgery and three months after taking mifepristone. Recording how many uterine leiomyomas recur and how many patients who required to keep their reproductive function have successfully get pregnant in the eighty-eight patients who had received hysterectomy in Jinan Military General Hospital from January 2005 to January 2006, and had taken mifepristone in the same way.2. Collecting eighty patients, pathological sections who have received hysterectomy because multiple uterine leiomyomas, including thirty cases of uterine leiomyoma organization, thirty cases of uterine leiomyoma surrounding tissue, twenty cases of normal uterus smooth muscle tissue, among them there are forty-five cases of reproductive period, twenty-seven cases of peri-menopausal period, and eight cases of menopause. In this study, we used s-p immunohistochemistry technology to detect the expression of estrogen receptor and progesterone receptor in above tissue and to compare them.The SPSS17.0 software is used for statistical analysis in testing this experimental datas, T-test is used in measurement datas, counting material with X2 inspection. The cut-point is determined at ninety-five percent, when p-value is less than zero point zero five, it is considered to be statistically significant.Results1. One week after taking mifepristone compared with before using this drug, estrogen increased in follicular phase and progesterone reduced in luteal phase. The difference is statistically significant (p-value is less than zero point zero five), follicle stimulating hormone, luteinizing hormone, progesterone in follicular phase and estrogen in luteal phase have not apparently change.2. Three months after taking mifepristone compared with before using this drug, estrogen, progesterone, follicle stimulating hormone, luteinizing hormone all reduced, especially the progesterone in luteal phase (p-value is less than zero point zero one), All the patients are temporary amenorrhea, without any obvious uncomfortable during taking drugs.3. Three months after stop taking mifepristone compared with before using this drug, the change of estrogen, progesterone, follicle stimulating hormone, luteinizing hormone is not statistically significant whether in follicular phase or luteal phase (p-value is more than zero point zero five). Liver function, kidney function, blood sugar, blood fat, adrenal cortical hormone of patients are all normal during taking mifepristone. After stopping taking the drugs, all patients, menstruation reback and menstrual cycles is regular.4. The positive rate of estrogen receptor and progesterone receptor in uterine leiomyoma organization and uterine leiomyoma surrounding tissue, are obviously higher than normal uterus smooth muscle tissue; the positive rate of estrogen receptor and progesterone receptor is higher than that in uterine leiomyoma surrounding tissue (p-value is less than zero point zero five).5. The positive rate of estrogen receptor in menopause is obviously higher than witch in reproductive period and peri-menopausal, and there are not significant changes between the later two groups. There are not significant change of the positive rate of progesterone receptor during reproductive period, peri-menopausal and menopause (p-value is more than zero point zero five).6. None of the thirty-six patients relapse after the surgeryin one year.Through observation of the eighty-eight patients for five years who had received hysteromyomectomy in Jinan Military General Hospital from July 2006 to July 2007, and have taken mifepristone in the same way, no uterine leiomyoma relapse. Among them there are seventeen patients who required keeping theirs reproductive function, twelve person have successfully pregnant; the pregnancy rate is seventy point six percent.Conclusion1. One week after taking mifepristone compared with before using this drug, estrogen increased in follicular phase and progesterone reduced in luteal phase, three months after taking mifepristone compared with before using this drug, estrogen, progesterone, follicle stimulating hormone, luteinizing hormone all reduced, especially the progesterone in luteal phase, above all we can draw a conclusion that reducing the level of sex hormones is one of the possible mechanism about how mifepristone can prevent multiple uterine leiomyomas recurring.2. No uterine leiomyoma relapse neither in the eighty-eight patients who had received hysteromyomectomy in Jinan Military General Hospital from January 2005 to January 2006, and was followed up for five year, nor in the thirty-six patients in this study who were followed up for one year. We can draw the conclusion that the prevention of mifepristone to multiple uterine leiomyomas is certain in the near future.3. All the sex hormone and the menstrual cycle have not apparently change, the blood tests are still normal, the patients have no obvious discomfort during taking drugs, so we can conclude that it is safe and reliable to take mifepristone in short time, the influence of ovarian function is recoverable, it has very important significance to retain the reproductive function of the patients who have not baby.4. After stopping taking mifepristone giving random curettage, one case is uterine endometrial polyps in ten pathology results, it indicates that being in continued low estrogen action, without progesterone to against have a certain effects on uterine endometrium, but the side effect is benign and treatable.5. The positive rate of estrogen receptor and progesterone receptor in uterine leiomyoma organization is obviously higher than normal uterus smooth muscle tissue or uterine leiomyoma surrounding tissue, so we can conclude that the high expression of estrogen receptor and progesterone receptor in uterine leiomyoma organization is one possible mechanism of how multiple uterine leiomyomas appeared, that is also the theory basis to taking mifepristone.6. The level of estrogen and progesterone in postmenopausal peripheral blood have fell to very low, but uterine leiomyoma in a few postmenopausal people still continue to grow, that is probably closely related to the continuous high expression of estrogen receptor.