복강경하 자궁근종절제술 전 GnRH agonist 치료 효과 = Effects of the GnRH agonist therapy before Laparoscopic myomectomy

국문 초록 (Abstract)

목적: 가임 여성에서 복강경적 자궁근종절제술 전 GnRH agonist 처치의 치료효과를 알아보고자 하였다. 연구 방법: 2003년 10월부터 2004년 9월까지 자궁근종절제술 전 GnRH agonist 치료를 한 환자들을 대상으로 조사하였다. 결과: 환자들의 평균연령은 37.8±4.5세이고, 7 (35%)명이 미분만부였다, 평균 3.04회의 GnRH agonist 전처치가 행해졌으며, 수술의 적응증은 과다월경 (13/20, 65%), 월경통(7/20, 35%), 촉지골반종양 (6/20, 30%)등이었다. 초진 초음파에서 가장 큰 근종의 지름이 평균 79.8㎜로, GnRH agonist 전처지 후 평균 60.8㎜로 감소하였으며, 용적으로는 평균 55.8%의 감소가 나타났다. 이중 18명은 복강경하 자궁근종절제술을 시행하였으며, 2명은 이전의 수술로 인한 유착과 거대 자궁 근종으로 인해 개복술로 전환되었다. 평균 수술 시간은 125±51분이었다. 수술 전후로 Hb은 평균 1.6 g/dL 감소하였고, 평균재원기간은 3.9±1.1일 개복술인 경우 8.5±2.1일였다. 결론: 자궁근종절제술에 앞서 GnRH agonist의 전처치는 근종의 크기를 감소하는데 효과적이며, 이는 복강경하 근종절제술을 용이하게 해줄 수 있을 것이다.

다국어 초록 (Multilingual Abstract)

Objective: The aim of this study was to evaluate the effectiveness of GnRH agonist therapy prior to the planned myomectomy for the women who want to preserve their fertility. Methods: We reviewed 20 patients who had GnRH agonist therapy prior to the planned myomectomy from October 2003 to September 2004. Results: Mean age of the patients was 37.8±4.5 y and nulliparous women were 7 (35%) among 20. Average 3.05 (range 1-4) times of GnRH agonist injection was done prior to a surgery. Indications of myomectomy were menorrhagia (13/20, 65%), dysmenorrhea (7/20, 35%), and palpable pelvic mass (6/20, 30%). Average of the longest diameter of the largest myoma was 79.8㎜ at first visit ultrasonography, and reduced to 60.8㎜ after the completion of GnRH agonist treatment. This means that average 55.8% of volume reduction was achieved by GnRH agonist. Among 20 patients, 18 (90%) had laparoscopic myomectomy and 2 (10%) had laparotomy. Of the 2 patients who had laparotomy, one had severe adhesion caused by prior pelvic surgery and another had very large myoma which was refractory to the GnRH agonist therapy. The global mean operative time was 125±51 min. Average hemoglobin drop after operation was 1.6 g/dL and no patient had transfusion. Total hospital stay was 3.9±1.1 days for patients who had laparoscopic myomectomy and 8.5±2.1 days for patients who had laparotomy. Conclusion: The use of GnRH agonist prior to the planned myomectomy was effective in reducing myoma volume and it enables surgeons to choose less invasive surgical approach.

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