Objective: 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. Methods: 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 (CA125), uterine volume and hemoglobin value. The dysmenorrhea score, uterine volume, hemoglobin value and CA125 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. Results: 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) cm3], hemoglobin value [(74.1±10.7) vs (102.5±13.5) g/L], and CA125 level [(104±76) vs (64±51) kU/L] were statistically different (all P<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)×109/L vs (9.90±0.10)×109/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 P<0.05). Conclusion: 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.
目的： 探讨子宫体积≥孕12周且合并中~重度贫血的子宫腺肌病患者行子宫全切除术前使用促性腺激素释放激素激动剂（GnRH-a）预处理的价值。 方法： 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全切除术的子宫腺肌病患者689例的临床资料，所有患者初诊子宫体积≥孕12周且合并中~重度贫血。根据术前用药情况分为研究组（127例）和对照组（562例），研究组术前行GnRH-a预处理3个疗程后再手术，对照组直接手术。采用SPSS 26.0软件对两组患者通过倾向性评分匹配进行1∶1匹配，匹配变量包括年龄、体重指数、孕次、产次、盆腹腔手术史、月经周期、经期、痛经评分、初诊癌相关抗原125（CA125）水平、初诊子宫体积、初诊血红蛋白含量。对比研究组患者GnRH-a用药前后的痛经评分、子宫体积、血红蛋白含量、CA125水平，并比较两组患者的手术时间、术中出血量、术后白细胞计数、围手术期输血例数、术后病率例数、住院时间及总费用。 结果： 经倾向性评分匹配，最终研究组和对照组各119例患者纳入本研究。研究组患者注射GnRH-a前、后，其痛经评分［分别为（7.4±1.7）、（5.6±1.8）分］、子宫体积［分别为（362±160）、（233±126）cm3］、血红蛋白含量［分别为（74.1±10.7）、（102.5±13.5）g/L］、CA125水平［分别为（104±76）、（64±51）kU/L］均有显著改善（P均<0.05）。研究组与对照组的手术时间［分别为（86±18）、（116±31）min］、术中出血量［分别为（24±9）、（43±22）ml］、术后白细胞计数［分别为（9.80±0.10）×109/L、（9.90±0.10）×109/L］、围手术期输血例数［分别为7例（5.9%，7/119）、73例（61.3%，73/119）］、术后病率例数［分别为6例（5.0%，6/119）、19例（16.0%，19/119）］、住院时间［分别为（7.1±1.6）、（7.9±1.6）d］、总费用［分别为（35 323±5 275）、（37 159±5 640）元］分别比较，差异均有统计学意义（P均<0.05）。 结论： 对于子宫体积≥孕12周合并中~重度贫血的子宫腺肌病患者，行子宫全切除术前使用GnRH-a预处理不仅有利于改善患者痛经、贫血、子宫体积增大的症状和体征，且有利于手术实施，减少术中、术后并发症，降低治疗费用。.