錨固定曼月乐治疗大子宫腺肌病的临床研究

Anchor-fixed Mirena in treatment of large adenomyosis:a clinical study

目的 探讨錨固定曼月乐(LNG-IUS)对大子宫腺肌病的治疗效果.方法 将大子宫腺肌病患者40例随机分为两组,研究组采用錨固定曼月乐治疗,对照组采用醋酸亮丙瑞林预处理3个月子宫缩小后上曼月乐.随访12个月,比较两组宫内放置曼月乐后1、3、6、12个月痛经程度、月经量、子宫大小、不良反应等指标.结果 研究组和对照组痛经程度和月经量均随时间增加而呈下降趋势,且到12个月时两组下降到相同水平;研究组子宫大小持续下降,对照组子宫大小1个月下降幅度明显优于研究组,3~6个月变化平稳,6个月后转为下降,12个月两组子宫大小无差异.在低雌激素表现方面研究组优于对照组,两种治疗方法其他不良反应率一致.结论 治疗初期GnRH-a+曼月乐组优于锚固定曼月乐组,长期疗效趋于一致,可以对大子宫腺肌病患者行锚固定曼月乐治疗替代GnRH-a+曼月乐疗法.

Objective To investigate the therapeutic effect of anchor?fixed Mirena(LNG?IUS)in the treatment of large adenomyosis.Methods Forty patients with large adenomyosis were randomly divided into two groups.The study group was treated with anchor?fixed Mirena,and the control group was pretreated with Leuprolide acetate(GnRH?a)for 3 months,and Mirena was used after the uterine size was reduced.After 12 months of follow?up,the dysmenorrheal degree,menstrual flow volume,uterine size,and adverse reactions at 1,3,6 and 12 months after intrauterine placement of Mirena were compared between the two groups.Results Both the study group and the control group showed a decreasing trend of dysmenorrheal degree and menstrual flow volume with the increasing time,and those in the two groups fell to the same level at 12 months.The uterine size in the study group continued to decrease.In the control group,the uterine size decreased more significantly than that in the study group at 1 month,and the change was stable between 3 and 6 months,whereas the size decreased after 6 months.There was no difference in the uterine size at 12 months between the two groups.In terms of low estrogen,the study group performed better than the control group,whereas there was consistency in the incidence of other adverse reactions between the two groups.Conclusion:The efficacy in the GnRH?a+Mirena group is better than that in the anchor?fixed Mirena group in the early stage of treatment,whereas the long?term efficacy tends to be consistent.Anchor?fixed Mirena may replace GnRH?a+Mirena in the treatment of large adenomyosis.