Effect Of Laparoscopic Combined With GnRha On The Treatment Of Uterine Fibroids In The Large Gestational Week

Objective:To evaluate the curative effects of the preoperative use of gonadotropin releasing hormone-analogue(Gn RHa)for hysteromyoma patients with the uterine volume larger than14 gestational weeks,treatment effects of laparoscopic minimally invasive surgery,and influence of the postoperative use of GnRHa on uterine fibroid relapse.Methods:Divided hysteromyoma patients coming to our hospital from September 2014 to September 2015 into observation and control groups.Patients with uterine volume larger than 14 gestational weeks were categorized into the observation group(n=25),who were treated with Gn RHa subcutaneous injection for two courses before operation and received laparoscopic surgery two weeks after withdrawals.Those with uterine volume ranging from10-12 gestational weeks were classified into the control group(n=36).Efficacy of the Gn RHa pretreatment could be evaluated through comparison of uterine fibroid volume and hemoglobin(Hb)change in the observation group before and after the treatment,while the efficacy of the operation could be assessed by comparing operation time,intraoperative blood loss,and transfusion circumstance in the control group.Then divided observation and control groups into two groups according to will of patients respectively,namely A1(n=14),A2(n=11),B1(n=20),and B2(n=16).Groups A1 and B1 were treated with 2 courses of Gn RHa,while the other two groups had no further treatment.Comparing results of four groups could be used to evaluate the influence of the postoperative use of Gn RHa on uterine fibroid relapse.Results : After the observation group received two courses of preoperative treatment of Gn RHa,the uterine volume was effectively reduced from(511.2 ± 37.9 cm3)to(302.5 ±46.8 cm3),the volume of fibroids was reduced from(151.2 ± 23.7 cm3)to(86.5±21.5 cm3),and the hemoglobin level was increased from(89.7 ± 23.4 g/L)to(123.8 ± 16.9 g/L).Therefore,we can conclude that the differences were statistically significant(P <0.05).All61 patients received laparoscopic hysteromyomectomy and none of them were conversed to laparotomy.Compared with the control groups,operation time in observation groups was(79.3±19.1 min)&(92.8±24.7 min),intraoperative blood loss was(253.8±87.5 ml)&(298.4±76.1 ml)and the amount of blood transfusion cases was 2(8%)&11(30.6%).The differences were statistically significant(P<0.05).Meanwhile,through 12-month postoperative follow-up,postoperative recurrence rates in groups A1,A2,B1,and B2 were separately 0%,27.3%,25%,and 37.5%,from which we can find that the recurrence rate of group A1 is dramatically lower than those of other groups.The differences were also statistically significant(P <0.05).Conclusion:1.Preoperative use of two courses of GnRHa for patients with uterine fibroids can obviously reduce the volume of uterine and fibroid,and increase hemoglobin levels,which promotes the success of laparoscopic surgery.Continual use after surgery can reduce the recurrence rate.2.It is possible to achieve laparoscopic surgery in patients with uterine fibroids,which can also reduce the difficulty and intraoperative bleeding,as well as shorten operation time.3.Preoperative and postoperative treatment combined with use of Gn RHa can reduce the recurrence rate of laparoscopic hysteromyomectomy.