分析经用促性腺激素释放激素类似物(GnRH-a)预处理后，腹腔镜行子宫肌瘤切除术的手术效果、适应证及并发症。

回顾性分析直径大于5 cm肌瘤的腹腔镜肌瘤切除术，其中28例术前给予曲普瑞林醋酸盐(diphereline，达菲林)(研究组)，36例未用药(对照组)，比较两组的手术时间、术中出血量及手术并发症等。

①研究组中每例患者肌瘤1〜2个，共切除肌瘤32个，未用药前超声测量肌瘤平均直径为6. 5 cm；切除术后平均直径为3. 2 cm。对照组中每例患者肌瘤1〜3个，共切除肌瘤41个，术前超声测量肌瘤平均直径为5. 9 cm；切除术后测量平均直径为5. 7 cm。术前两组肌瘤直径比较，差异无显著意义(P>0. 05)，切除术后两组肌瘤直径比较，研究组肌瘤直径明显缩小，肌瘤体积平均缩小率51%，两组比较差异有显著意义(P<0. 01)。②研究组中有9例进行了缝合，手术时间为(45±18)min，出血量为(60±25)ml;对照组中有12例进行了缝合，手术时间为(92±32)min，出血量为(110±105)ml，两者比较，研究组手术时间及出血量均明显减少，差异有显著意义(P<0. 01，P<0. 05)。③研究组、对照组组术后平均住院时间分别为4. 2 d及4. 8 d，术后2个月后随访，两组术前有症状者术后均改善。研究组1例术后1⁺ 年肌瘤复发，再次行腹腔镜子宫肌瘤切除术。

对于较大体积的子宫肌瘤术前应用GnRH-a 3个月，可明显缩小肌瘤体积，缩短手术时间，减少术中出血量。

Analyse about the effect, application and the contraindication of GnRH-a agonist therapy before laparoscopic hysteromyomectomy.

A retrospective study of laparoscopic hysteromyomectomy of the leiomyoma is longer than 5 cm. Of them 28 cases given GnRH-a(investigation group),36 cases without any disposal(comparison group), compare the operation time, bleeding quantity and the operation syndrome of the 2 groups.

①In the investigation group, every case includes 1 〜2 leiomyoma, aggregately 32 leiomyoma was excised. Without any drug diameter of the average leiomyoma is 6. 5 cm, after the resection the diameter of the average leiomyoma is 3. 2 cm; in the comparison group, every case 1〜3 leiomyoma. Without any drug diameter of the average leiomyoma is 5. 9 cm, after the resection the average diameter of the leiomyoma is 5. 7 cm. Before the operation there's no notable difference between the 2 groups of the diameter(P>0. 05). After the operation, the diameter of the investigation group is remarkably shorten. There's notable difference(P< 0. 01).② In the investigation group, there are 9 cases were sewed up, operation time is(45±18)minutes and average bleeding quantity is(60±25)ml. In the comparison group, there are 12 cases were sewed up, operation time is(92 ± 32)minutes and average bleeding quantity is(110± 105)ml. The operation time and the bleeding quantity of the investigation group is remarkably reduced(P <0. 01, P < 0. 05). ③ the investigation group and the comparison group treatment time is separately 4. 2 and 4. 8 days. 2 months after the operation, the sufferers of 2 groups both mended. 1 case of the investigation group was resected with celioscope again in 1⁺ year.

Applying GnRH-a 3 months before the operation to those bigger leiomyoma can remarkably reduce the volume of the leiomyoma, operation time and bleeding quantity.