Chen M G, Zhao M L, Fu H L, Mao M, Wang Q, Guo R X
Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Fu Chan Ke Za Zhi. 2023 Aug 25;58(8):589-594. doi: 10.3760/cma.j.cn112141-20230607-00257.
To evaluate the efficacy of gonadotropin-releasing hormone agonist (GnRH-a) pretreatment before total hysterectomy for adenomyosis patients with uterine volume ≥12 gestational weeks and moderate or severe anemia. From January 2018 to March 2023, 689 patients who underwent total hysterectomy for adenomyosis in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. According to the preoperative medication, they were divided into study group (127 cases) and control group (562 cases). Patients in the study group underwent GnRH-a pretreatment for 3 cycles before surgery, and the control group received operation directly. SPSS 26.0 software was used to perform 1∶1 matching for the two groups of patients through the propensity score matching method. Matching variables included age, body mass index, gravidity, parity, history of pelvic and abdominal surgery, menstrual cycle, menstrual period, dysmenorrhea score, initial diagnosis of cancer antigen 125 (CA), uterine volume and hemoglobin value. The dysmenorrhea score, uterine volume, hemoglobin value and CA level before and after GnRH-a pretreatment in the study group were compared. And the duration of operation, intraoperative blood loss, postoperative white blood cell count, perioperative blood transfusion cases, postoperative disease rate, duration of hospitalization, total hospitalization cost between the two groups were compared. With propensity score matching, 119 patients in the study group and 119 patients in the control group were finally enrolled in this study. In the study group, before and after the treatment with GnRH-a, the dysmenorrhea score (7.4±1.7 vs 5.6±1.8), uterine volume [(362±160) vs (233±126) cm], hemoglobin value [(74.1±10.7) vs (102.5±13.5) g/L], and CA level [(104±76) vs (64±51) kU/L] were statistically different (all <0.05). There were statistical differences of operation time [(86±18) vs (116±31) minutes], intraoperative blood loss [(24±9) vs (43±22) ml], white blood cell count after 1 day of operation [(9.80±0.10)×10/L vs (9.90±0.10)×10/L], number of perioperative blood transfusion case [5.9% (7/119) vs 61.3% (73/119)], postoperative disease rate [5.0% (6/119) vs 16.0% (19/119)], hospitalization duration [(7.1±1.6) vs (7.9±1.6) days], and total hospitalization cost [(35 323±5 275) vs (37 159±5 640) yuan] between the study group and the control group (all <0.05). The pretreatment of using GnRH-a before total hysterectomy for adenomyosis patients with uterine volume ≥12 gestational weeks and moderate or severe anemia is not only conducive to improving dysmenorrhea, signs of anemia, reducing uterine volume, but also conducive to the implementation of surgery, reducing intraoperative and postoperative complications, and reducing hospital costs.
评估促性腺激素释放激素激动剂（GnRH-a）预处理对子宫体积≥12孕周且合并中度或重度贫血的子宫腺肌病患者行全子宫切除术的疗效。回顾性分析2018年1月至2023年3月在郑州大学第一附属医院行子宫腺肌病全子宫切除术的689例患者。根据术前用药情况，将其分为研究组（127例）和对照组（562例）。研究组患者术前接受GnRH-a预处理3个周期，对照组直接接受手术。采用SPSS 26.0软件通过倾向评分匹配法对两组患者进行1∶1匹配。匹配变量包括年龄、体重指数、孕次、产次、盆腔及腹部手术史、月经周期、经期、痛经评分、癌抗原125（CA）初始诊断值、子宫体积及血红蛋白值。比较研究组GnRH-a预处理前后的痛经评分、子宫体积、血红蛋白值及CA水平。并比较两组的手术时间、术中出血量、术后第1天白细胞计数、围手术期输血例数、术后疾病发生率、住院时间、总住院费用。经倾向评分匹配后，最终研究组119例患者和对照组119例患者纳入本研究。研究组GnRH-a治疗前后痛经评分（7.4±1.7 vs 5.6±1.8）、子宫体积[（362±160） vs （233±126）cm]、血红蛋白值[（74.1±10.7） vs （102.5±13.5）g/L]及CA水平[（104±76） vs （64±51）kU/L]差异有统计学意义（均P<0.05）。研究组与对照组在手术时间[（86±18） vs （116±31）分钟]、术中出血量[（24±9） vs （43±22）ml]、术后第1天白细胞计数[（9.80±0.10）×10⁹/L vs （9.90±0.10）×10⁹/L]、围手术期输血例数[5.9%（7/119） vs 61.3%（73/119）]、术后疾病发生率[5.0%（6/119） vs 16.0%（19/119）]、住院时间[（7.1±1.6） vs （7.9±1.6）天]及总住院费用[（35 323±5 275） vs （37 159±5 640）元]方面差异均有统计学意义（均P<0.05）。对于子宫体积≥12孕周且合并中度或重度贫血的子宫腺肌病患者，全子宫切除术前使用GnRH-a预处理不仅有利于改善痛经、贫血症状，缩小子宫体积，还有利于手术的实施，减少术中及术后并发症，降低住院费用。
