자궁근종의 약물치료 (GnRH Agonist) 에 대한 효용성에 관한 연구 = A Clinical study on Effect of GnRH agonists for Uterine Myoma

다국어 초록 (Multilingual Abstract)

Forty five women with symptomatic uterine myomas, who had already been treated with GnRH agonist as outpatietns in Obstetrics and Gynecology of Chunan Hospital, S.C.H University from March 1995 to February 1997, were retrospected and analyzed about effect and side-effects of GnRH agonist with the results over statistical method of the pelvic ultras onography and the hormone check level in blood.
The clinical study was aslo examined and studied alleviation maintenance of symptoms, degree of regrowth, and its final future for treatment. Used GnRH agonist types were Decapepty1, Leuprolide and Nafarelin, and the results of the study is as follows.
1. Size of uterine myomas of forty two(93.3%) among forty five women treated with hormone for six months showed reduction of volume as 42.8 ± 4.4% of the first-size except three(p ＜ 0.0005). Twenty seven(60%) among forty five women could undergo easy operation and had less complications like bleeding. And the rest fifteen(33.3%) among eiteen women(40%) could get satisfactory effects only with GnRH agonist therapy. We changed GnRH agonist type for the rest three women(6.7%) after six months and it was decided the case that treatment effect was low.
2. There were no significant regression in serum LH and FSH(p ＞ 0.05), but serum Estradiol levels fell significantly 4 weeks after first therapy(148.7 ± 20.5pg/ml to 29.7 ± 19.5pg/ml) till 24 weeks (to 17.9 ± 0.9 pg/ml)(p ＜ 0.005).
3. Clinical symptoms due to uterine myomas decreased or disappeared 4∼8weeks after first therapy.
4. From 4 weeks after the last GnRH agonist treatment, Estradiol level was 25 ± 14.8pg/ml and showed gradual increase, and volume of the reduced myoma uteri increased gradually from 42.8 ± 4.4% at the last therapy to 49.6 ± 2.7% 8 weeks after last therapy(p ＜ 0.005).
5. The most common side effect was hot flush(82.2%) and the others included vaginal dryness(37.8%), fatigue and interest decline(46.7%), headache and insomnia(33.3%). However, symptoms like general weakness weight loss and osterporosis were rare, and there was no case to stop treatment due to these symptoms. And these symptoms were disappeared with resumption of menstruation after the therapy.
6. There were potential advantages of GnRH agonist therapy before myomectomy or total abdominal hysterectomy such as; (1) easier and safer to isolate the myomas; (2) less intraoperative blood loss; (3) less complications after myomectomy or total abdominal hysterectomy.
7. GnRH agonist used in this study includes Decapeptyl, Leuprolide and Nafarelin, and there was no difference for effect and side-effects of each type.
Considering the above results, GnRH agonist treatment for myoma uteri is regarded to be effective, but more further study and report is desirable for new hormone replacement therapy to prevent regrowth of myoma uteri after treatment stop and estrogen dependent side-effect in treatment.