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題名 | Major Hemorrhage in a Patient with Multiple Submucous Leiomyomata during the Treatment of Long-Acting Gonadotropin-Releasing Hormone Agonist=使用長效型性腺釋放激素對抗物(GnRH-agonist)治療子宮內膜下肌瘤卻引發大量出血的病例報告 |
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作者 | 王冠今; 李文齡; 袁九重; 王鵬惠; Wang, Kuan-chin; Lee, Wen-ling; Yuan, Chiou-chung; Wang, Peng-hui; |
期刊 | The Kaohsiung Journal of Medical Sciences |
出版日期 | 20000200 |
卷期 | 16:2 2000.02[民89.02] |
頁次 | 頁103-107 |
分類號 | 417.281 |
語文 | eng |
關鍵詞 | 長效型性腺釋放激素對抗物; 子宮內膜下肌瘤; 出血; Gonadotropin releasing hormone agonist; GnRH-agonist; Major hemorrhage; Submucous myomata; |
中文摘要 | 長效型性腺釋放激素對抗物( GnRH-agonist )用來輔助治療良性子宮肌瘤,尤 其在手術之前的使用已廣為人知,但其隱藏的危險性卻常被忽略。本文我們報告一位 23 歲 單身女子因為多發性的子宮內膜下肌瘤,而接受性腺釋放激素對抗物的治療後之罕見併發症 。此 23 歲單身女子因每次經血過多而導致貧血有半年之久,超音波檢查顯示子宮內膜下多 發性肌瘤,於是其接受長效型性腺釋放激素對抗物治療。此病人反應良好,在第一劑注射後 即達到停經的狀態。 子宮的體積及全部的肌瘤體積分別減少 21% 和 27%。然而在開始治療 後的第六十五天,其突然併發陰道大出血並快速導致出血性休克。經過急救後,此病人接受 立即子宮鏡指引下內試鏡肌瘤切除並且使用 30 毫升的 Foley 壓迫止血, 接著使用賀爾蒙 補充治療。一周後置入子宮內避孕器並繼續賀爾蒙治療。又經過四個月的治療,病人結婚懷 孕,迄今已經妊娠二十二周了。本文充分顯示雖然長效型性腺釋放激素對抗物用來輔助治療 良性子宮肌瘤擁有許多的好處,包括暫時性減少腫瘤體積,減少出血以及提供貧血的改善機 會,但是其潛在的危險性,卻不容忽視。諸如本文所報導的病例一樣,此少見且不能預期的 危險須時時牢記在心。 |
英文摘要 | Gonadotropin releasing hormone agonist (GnRH-agonist) therapy has been useful as an adjunct before myomectomy or hysterectomy for uterine myoma but the concealed risk is often overlooked. We report an extremely rare clinical presentation of a patient with multiple submucosal myomata during the treatment of long-acting gonadotropin-releasing hormone agonist (GnRH-agonist) in a 23-year-old, virgin woman. This patient exhibited heavy menstruation and severe anemia for half of a year. Ultrasound demonstrated multiple submucous myomata and intramural myomata. She received a conservative medical treatment by GnRH-agonist. The patient showed marked suppression of serum estradiol concentrations throughout treatment (<20 pg/ml since first dose injection). The volume of the uterus decreased 21% and the total volume of the uterine myomata decreased 27% at the end of the second dose injection. However, a sudden onset of major hemorrhage occurred at the 65th day without "add-back" hormonal replacement therapy after initial therapy of GnRH-agonist. Hypovolemic shock followed soon and immediately resuscitation was performed. After resuscitation, the patient was treated with hysteroscopic myomectomy, followed by 30ml balloon Foley catheter placement for compressing the intrauterine rough surface and hormonal replacement therapy. When uterus returned to the normal size at the end of the first week, intrauterine device was positioned and maintained for three months. The patient married four months later and got pregnant soon. Now she has a pregnancy of 22 gestational weeks. The phenomenon suggests presence of concealed and potential risk of GnRH-agonist for managing a patient with multiple submucous myomata, even though GnRH-agonist is a welldocumented transient treatment for uterine myomata not only by its effect on tumor shrinkage and decreasing blood loss during the myomectomy but also by providing a time for hematological recovery. This unexpected and unwanted clinical presentation should be alerted. |
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