米非司酮在绝经过渡期子宫腺肌病的应用

Application of mifepristone in the treatment of adenomyosis during menopausal transitional period

目的 探讨米非司酮治疗子宫腺肌病的临床效果 ,减少绝经过渡期子宫全切除手术。方法 对 36例依临床症状、彩色超声或核磁 (MRI)检查诊断为子宫腺肌病 ,年龄在 4 0岁以上 ,处于绝经过渡期的患者 ,口服米非司酮 (1 0mg,1日 1次 )连续 3个月 ,治疗前后行妇科检查、子宫、附件阴式B超检查 ,同时观察月经量、痛经程度、子宫体积及CA1 2 5等变化。结果 治疗前与治疗后 3个月比较 :8例患者出现闭经 ,2 8例月经量明显减少 (P <0 0 1 ) ,月经周期、经期无明显变化 ;2 7例患者痛经完全消失 ,6例明显缓解 ,3例复发 ;治疗后疼痛评分及痛经分级比治疗前明显降低 (P <0 0 1 ) ;B超测量子宫体积明显缩小 ;CA1 2 5下降明显。 6个月后 ,5例闭经 ,2 1例月经量明显减少 ,1 0例恢复同治疗前 ;1 4例患者痛经完全消失 ,2 0例明显缓解 ,2例复发。结论 米非司酮治疗子宫腺肌病 ,能有效控制痛经 ,减少月经量 ,诱导闭经 ,近期疗效明显 ,用于绝经过渡期患者可避免子宫。

Objective To assess the clinical effects of mifepristone in the treatment of adenomyosis during menopausal transitional period. Methods Mifepristone were taken 10mg qd for 3 months continuously by 36 patients older than 40 years old with adenomyosis at menopausal transition. After treatment,the symptoms,uterine size and CA 125 were compared. Results At three months after treatment,all clinical symptoms of 36 patients relieved.Amenorrhea was induced in 8 patients; bleeding amount immediately decreased in 28 patients ( P <0 01).Dysmenorrhea completely disappeared in 27 patients,significantly alleviated in 6 and the other 3 recurred.The uterine shrunk significantly; CA 125 was decreased.After 6 months,amenorrhea was induced in 5 patients,bleeding amount reduced significantly in 21 patients; yet the other 10 were as the same as that before treatment.Dysmenorrhea completely disappeared in 14 patients,significantly alleviated in 20 and the other 2 recurred. Conclusions Mifepristone is effect in the treatment of adenomyosis during menopausal transitional period.