De Falco Marianna, Staibano Stefania, Mascolo Massimo, Mignogna Chiara, Improda Luigi, Ciociola Francesca, Carbone Ilma F, Di Lieto Andrea
Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, University "Federico II" of Naples, Italy.
Eur J Obstet Gynecol Reprod Biol. 2009 May;144(1):44-7. doi: 10.1016/j.ejogrb.2009.02.006. Epub 2009 Mar 17.
To evaluate if pre-operative GnRH-a modify uterine leiomyoma pseudocapsule and the possible clinical effects of these changes.
The study was performed at the University Federico II of Naples on 33 premenopausal patients submitted to laparotomic myomectomy after treatment with triptorelin depot. 29 untreated patients formed the control group. The operating time, the intraoperative bleeding and the prompt identification of the cleavage plan between myoma and myometrium were evaluated. The pseudocapsule features and the immunoexpression of PCNA and CD34 in this area were studied.
Treated patients showed lower blood loss and not clearly identifiable cleavage plan, but without any significant increase in the operating time. Treated lesions showed less evident border between myoma and myometrium and lower PCNA and CD34 pseudocapsule immunoexpression than untreated ones.
We propose the changes of leiomyoma pseudocapsule as partial explanations of the reported clinical and surgical findings after pre-operative GnRH-a.
评估术前使用促性腺激素释放激素激动剂（GnRH-a）是否会改变子宫平滑肌瘤假包膜以及这些改变可能产生的临床影响。
该研究在那不勒斯费德里科二世大学进行，纳入了33例接受长效曲普瑞林治疗后行剖腹子宫肌瘤切除术的绝经前患者。29例未接受治疗的患者作为对照组。评估了手术时间、术中出血量以及肌瘤与子宫肌层之间分离平面的快速识别情况。研究了该区域假包膜的特征以及增殖细胞核抗原（PCNA）和CD34的免疫表达情况。
接受治疗的患者术中出血量较少，分离平面不清晰，但手术时间无明显延长。与未治疗的病变相比，接受治疗的病变肌瘤与子宫肌层之间的边界不明显，PCNA和CD34在假包膜中的免疫表达较低。
我们认为平滑肌瘤假包膜的改变可部分解释术前使用GnRH-a后所报道的临床和手术结果。
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