摘要
目的探讨促性腺激素释放激素激动剂（ＧｎＲＨα）在治疗子宫腺肌病伴不孕症中的作用。方法４例有严重痛经的子宫腺肌病伴不孕症患者经Ｂ超及腹腔镜或病理检查确诊，在腹腔镜检查的同时手术矫治合并存在的子宫内膜异位症和盆腔粘连。４例中，３例子宫后壁有局限性腺肌瘤形成（其中２例在腹腔镜下行手术切除）。３例于术后、１例于术前注射长效缓释型ＧｎＲＨα，每月１次，共６次。结果ＧｎＲＨα用药期间４例均闭经，血雌二醇于用药的第３周降到绝经期水平；用药６次后增大的子宫缩小至正常或接近正常。１例子宫后壁局限性腺肌瘤未行手术切除者，用药后腺肌瘤缩小７３．７％。３例于腹腔镜术后、停药转经的４个月内妊娠；另１例停药转经２个月，现在随访中。３例妊娠转归：１例足月剖宫产分娩；１例手术切除肌壁间腺肌瘤者，孕３０周时因先兆子宫破裂急诊行剖宫产术；１例目前孕２２周。结论（１）ＧｎＲＨα对抑制子宫腺肌病和促进病变子宫恢复受孕能力及维持妊娠有作用。（２）对肌壁间子宫腺肌瘤采用ＧｎＲＨα药物抑制法，可避免采用手术切除引起的妊娠时子宫破裂。（３）对合并严重的盆腔粘连者，ＧｎＲＨα术前用药可缩小子宫，减少盆腔充血，降低手术难度和术中出血。
Objective To Study the role of gonadotropin releasing hormone agonists (GnRH α)in the treatment of adenomyosis with infertility. Methods Adenomyosis was diagnosed under lapososcopy in 4 infertile cases. Meanwhile coexsting endometriosis,pelvic adhesion and adenomyoma were treated by surgery and endocoagulator in 4 and 2 cases respectively.GnRH α (triptorelin or goserelin ) therapy was given for six months before laparoscopic surgery in 1 case and after laparoscopic surgery in 3 cases .Their fecundity outcome were followed up after cessation of GnRH α treatment. Results All cases became amenorrheic during GnRH α therapy. The enlarged uteri all decreased to normal or near normal size. Menstruation returned in 80～90 days after cessation of treatment. Three cases conceived within four menstrual periods. One of them resulted in the birth of a healthy 3 150 g male at 38 weeks gestation by cesarean section. The second pregnancy resulting after adenomyomectomy was terminated by emergent cesarean section at 30 weeks gestation because of threatened rupture of uterus. The third is now normal at 28 weeks pregnancy .The fourth has had 2 menstrual periods and is still being followed up. Conclusion (1) GnRH α thus used is efficient in reducing the adenomyotic uterine size ,and may facilitate fertility. (2) For ademyomata associated with infertility, GnRH α therapy may avoid the risk of rupture of uterus which may occur after adenomyomectomy pregnancy. (3) For infertility, GnRH α treatment before laparoscopic surgery greatly decreases surgical diffculties and blood loss in certain cases.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
1999年第4期214-216,共3页
Chinese Journal of Obstetrics and Gynecology
