GnRHアナログ療法を併用したTLH症例におけるエストリオール腟錠の影響

抄録

Objective: Preoperative gonadotropin-releasing hormone analogue (GnRHa) therapy facilitates total laparoscopic hysterectomy (TLH) for uterine fibroids and adenomyomas by decreasing blood loss and operative time. However, GnRHa use can cause vaginal atrophy, making transvaginal procedures difficult. The aim of this study is to evaluate the effect of preoperative vaginal estriol use for TLH in patients on GnRHa therapy.

Methods: We retrospectively assessed 2,571 patients who underwent TLH with transvaginal specimen extraction between April 2014 and March 2023, of whom 2,505 were postmenopausal or undergoing GnRHa treatment. Patients were divided into two groups by vaginal estriol administration status. Patient characteristics, surgical outcomes, and postoperative outcomes were compared between the groups.

Results: No significant group differences were seen in age, BMI, proportion of nulliparas, serum estradiol and FSH levels, type and dose of GnRHa, and size and weight of uterus. In the analysis of surgical outcomes, the rate of colpoperineal laceration was significantly lower in the estriol group than in the non-estriol group (p<0.01). Operative time, blood loss, and specimen extraction time were similar in both groups. There were no significant group differences in hemorrhage from the vaginal stump requiring hospitalization or outpatient treatment for suture or pressure hemostasis.

Conclusion: This is the first study evaluating postoperative and surgical outcomes for vaginal estriol use in patients undergoing TLH on GnRHa therapy. Add-back therapy with vaginal estriol is effective for reducing the risk of colpoperineal laceration caused by transvaginal procedures. It may allow benefitting from GnRHa therapy while reducing its disadvantages.