左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床疗效观察和生活质量评估

The effect of a levonorgestrel-releasing intrauterine system on 63 women with adenomyosis.

目的观察和评估左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)治疗子宫腺肌病的临床疗效和生活质量。方法对63例子宫腺肌病患者放置LNG-IUS,并对其放环前及放环后第1、3、6、12月随诊观察比较痛觉视觉模拟评分(VAS)、月经量、子宫体积、血清生殖激素水平、比较放环前后综合心理健康指数(PGWBI)以评估其生活质量(Quality of life)。结果LNG-IUS治疗子宫腺肌病1年内,VAS评分由放置前的(81.1±5.8)降至(14±8.4)分,差异显著(P<0.01);月经量由放置前的(198±23)降至(27±6)ml,差异显著(P<0.01);PGWBI由放置前的(64.7±17)升至(81±13)差异显著(P<0.01),生活质量显著改善;子宫体积由放置前的(133±26)降至(121±24)cm3,差异显著(P<0.05);血清生殖激素水平差异无显著(P>0.05)。结论宫内放置LNG-IUS治疗子宫腺肌病是一种疗效显著、稳定、安全的保守性治疗方法,能显著提高患者生活质量。

Objective： Observe and evaluate clinical efficacy and security of a levonorgestrel - releasing intrauterine system （LNG-IUS） for adenomyosis. Methods： Before LNG -IUS insertion and after 1, 3, 6, 12 months, all patients were asked to complete a visual analog scale （VAS） form regarding pelvic pain, Pictorial blood loss assessment chart （PBAC） form regarding menstrual blood volume, Psychological General Well -Being Index （PGWBI） to assess Quality of life; color Doppler ultrasonography to evaluate uterus volume, the level of serum CA125 and E2, Po, LH, FSH were tested by radioimmunoassay Results： After the 12 - month visit, VAS and PBAC score was decreased significantly （ P 〈 0.05 ） , the mean PGWBI scores of 63 patients increased significantly （ P 〈0. 05） ; the change of sex hormone level before and after inserting ING- IUS didn＇t have statistical significance （ P 〉 0. 05 ）. Conclusion ： Inserting LNG - IUS in uterus is a significant curative effect conservative treatment of adenomyosis with long term effect and security, but also improve patients＇ psychological conditions significantly, display prominent increase on PGWBI.