Imankulova Balkenzhe, Mereke Alibek, Kamzaeva Nazira, Ukybassova Talshyn
Department of Obstetrics and Gynecology, National Research Center for Maternal and Child Health, National Medical Holding, Astana, Kazakhstan.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Cent Asian J Glob Health. 2015 Sep 17;4(1):232. doi: 10.5195/cajgh.2015.232. eCollection 2015.
Uterine fibroids are the most common benign tumor in women in Kazakhstan. In the past two decades, endoscopic surgery has played an important role in the development of gynecologic surgery, particularly in the treatment of uterine fibroids. The goal of this paper is to evaluate whether uterine artery embolization (UAE) or gonadotropin-releasing hormone agonists (GnRHa) prior to myomectomy was more effective in decreasing fibroid size and improving surgical outcomes in a pilot study of women in Kazakhstan.
This pilot investigation included 24 patients separated into 2 groups: medication group (pre-treatment with GnRHa - 13 patients) and embolization group (pre-treatment with UAE - 11 patients). All patients had uterine fibroids, 3-10 cm in diameter, and were treated with myomectomy at the National Research Center for Maternal and Child Health, Astana, Kazakhstan. All patient data were obtained by a retrospective medical records review. Descriptive statistics were utilized to characterize participant demographics data. Independent t-tests were used to analyze continuous variables, and Chi-square and Fisher's exact tests were used where appropriate for count data.
The group treated with GnRHa had an operating time of 40±10 minutes longer than the group treated with UAE, due to the peri-operative difficulties encountered by surgeons in detecting the layer between the myometrium and fibroid capsule. The group treated with UAE experienced better patient outcomes (less blood loss, less surgical time, and reduced use of anesthesia) and was a technically easier surgery due to visible differences in uterine layers.
Despite the fact that both treatments (GnRHa and UAE) were effective for fibroid shrinking, embolization resulted in more optimal surgical time and improved patient outcomes. Results of this pilot study need to be confirmed in a randomized clinical trial, specifically focused on Kazakhstan and the Central Asian Region.
子宫肌瘤是哈萨克斯坦女性中最常见的良性肿瘤。在过去二十年中，内镜手术在妇科手术发展中发挥了重要作用，尤其是在子宫肌瘤的治疗方面。本文的目的是在一项针对哈萨克斯坦女性的试点研究中，评估子宫肌瘤切除术之前进行子宫动脉栓塞术（UAE）或促性腺激素释放激素激动剂（GnRHa）治疗在减小肌瘤大小和改善手术结果方面是否更有效。
这项试点研究纳入了24名患者，分为两组：药物治疗组（术前使用GnRHa治疗 - 13名患者）和栓塞治疗组（术前使用UAE治疗 - 11名患者）。所有患者均患有直径3 - 10厘米的子宫肌瘤，并在哈萨克斯坦阿斯塔纳的国家母婴健康研究中心接受了子宫肌瘤切除术。所有患者数据均通过回顾性病历审查获得。使用描述性统计来描述参与者的人口统计学数据。采用独立t检验分析连续变量，对于计数数据，在适当情况下使用卡方检验和费舍尔精确检验。
由于外科医生在术中难以辨别子宫肌层和肌瘤包膜之间的层次，接受GnRHa治疗的组手术时间比接受UAE治疗的组长40±10分钟。接受UAE治疗的组患者手术效果更好（失血更少、手术时间更短、麻醉使用减少），并且由于子宫层次的明显差异，手术在技术上更简单。
尽管两种治疗方法（GnRHa和UAE）对肌瘤缩小均有效，但栓塞术带来了更优化的手术时间并改善了患者手术效果。这项试点研究的结果需要在一项专门针对哈萨克斯坦和中亚地区的随机临床试验中得到证实。
