Römer T
Department of Obstetrics and Gynecology, University Hospital, Ernst Moritz Arndt University, Greifswald, Germany.
Gynecol Obstet Invest. 1998;45 Suppl 1:12-20; discussion 21, 35. doi: 10.1159/000052847.
Hysteroscopic surgery is widely used for the treatment of patients suffering from menorrhagia. In different studies, pretreatment of the endometrium with GnRH analogues (GnRH-a) prior to endometrial ablation has been reported to increase the success rate, as well as to reduce the menstrual blood flow, accounting for a significantly higher postoperative amenorrhea rate (42% in pretreated patients vs. 24% in those receiving no pretreatment). The aim of pretreatment is not only to obtain a thin endometrium but also to reduce the size and vascularization of myomas being treated. In our study, GnRH-a administration prior to endometrial ablation was shown to have the following advantages: improved hysteroscopic view, reduced blood loss, absorption of uterine distending fluid and higher postoperative amenorrhea rates. Prior to hysteroscopic myoma resection, pretreatment with GnRH-a may be particularly indicated for all myomas with a diameter of more than 3 cm and/or with an intramural portion, or for patients suffering from secondary anemia. GnRH-a pretreatment is thus indicated before endometrial ablation, and in most cases, before hysteroscopic resection of submucous myomas, and combined medical and surgical therapy has clear benefits in the treatment of bleeding disorders.
宫腔镜手术广泛应用于治疗月经过多的患者。在不同研究中，据报道，在子宫内膜消融术前用促性腺激素释放激素类似物（GnRH-a）预处理子宫内膜可提高成功率，减少月经量，术后闭经率显著更高（预处理患者为42%，未预处理患者为24%）。预处理的目的不仅是获得薄的子宫内膜，还在于减小所治疗肌瘤的大小并减少其血管化。在我们的研究中，子宫内膜消融术前给予GnRH-a显示有以下优点：改善宫腔镜视野、减少失血、吸收子宫膨胀液以及提高术后闭经率。在宫腔镜下肌瘤切除术前，对于所有直径大于3 cm和/或有肌壁内部分的肌瘤，或对于患有继发性贫血的患者，可能特别需要用GnRH-a进行预处理。因此，在子宫内膜消融术前以及在大多数情况下，在宫腔镜下切除黏膜下肌瘤之前，均需进行GnRH-a预处理，联合药物和手术治疗在治疗出血性疾病方面有明显益处。
