左炔诺孕酮宫内缓释系统治疗子宫腺肌病疗效观察

Effect of levonorgestrel-releasing intrauterine system in the treatment of adenomyosis

目的探讨子宫腺肌病患者放置左炔诺孕酮宫内缓释系统(LNG-IUS;商品名:曼月乐)后的临床效果。方法2004年9月至2005年11月观察青岛大学医学院附属医院妇产科48例子宫腺肌病患者放置LNG-IUS前、3个月、6个月、12个月痛经评分、PBAC法经量评分、子宫体积及双侧卵巢体积、内膜厚度等多项指标变化。放置LNG-IUS第6、12个月抽取晨血查4项生殖激素:雌二醇(E2)、孕激素(P)、黄体生成素(LH)、卵泡刺激素(FSH)。结果痛经评分于放置前为12.20±2.85,放置后3个月为6.21±3.77,12个月为1.23±0.74,痛经明显减轻,与放置前比较,差异有显著性(P<0.01)。经量评分在放置前为194.47±52.20,放置后3个月为68.64±29.51,12个月为23.68±12.74,较放置前明显减少,差异有显著性(P<0.01)。1年内子宫体积和双侧卵巢体积大小无明显变化(P>0.05)。放置前内膜厚度为(9.3±1.4)mm,3个月内膜厚度为(9.0±1.1)mm(P<0.05),12个月内膜厚度为(6.5±1.1)mm(P<0.01),差异有显著性。放置6个月4项生殖激素维持在卵泡早中期水平,放置1年70%周期有黄体形成。结论LNG-IUS是治疗子宫腺肌病的一种较为有效且安全的方法。

Objective To observe the effect of LNG-IUS on adenomyosis. Methods Forty-eight patients with adenomyosis, aged from 28 to 43 years, were selected as observing subjects from September, 2004 to November, 2005. The menstrual blood loss, severity of dysmenorrheal, size of uteri and ovaries, as well as endometrial thickness were followed up in 0, 3, 6 and 12 months respectively following LNG-IUS insertion. The serum levels of E2 ,P, LH and FSH were analyzed in 6,12 months after the insertion. Results The dysmenorrheal scores and menstrual blood loss by PBAC, before and in 3,12 months following the insertion, were 12. 20 ± 2. 85 versus 6. 21 ± 3. 77,1.23 ± 0. 74 and 194. 47 ± 52. 20 versus 68. 64 ±29. 51,23. 68 ± 12. 74 respectively（ P 〈 0. 01 ）. The sizes of uteri and ovaries were not different from those before treatment （ P 〉 0. 05 ）. Endometrial thickness measured by ultrasonography reduced significantly from （ 9. 3 ± 1.4）ram to （9.0±1.1）mm in 3 months （P 〈0.05） ,to （6.5 ± 1.1）mm in 12 montbs（P 〈0. 01）. The serum levels of four sex hormones were in the level of early to mid-follicular phase in 6 months after the insertion, while in one year 70% menstrual cycles formed corepus luteum. Conclusion LNG-IUS is an effective and safe method for controlling the symptoms of adenomyosis in one year＇ s observation.