左炔诺孕酮宫内缓释系统治疗子宫内膜增生的疗效及安全性

Curative effect and safety of levonorgestrel-releasing intrauterine device on endometrial hperplasia

目的:观察左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫内膜增生的疗效及安全性。方法:151例子宫内膜增生症患者(排除子宫内膜癌)用曼月乐治疗,放置前和放置24个月内定期随访患者月经模式及血红蛋白水平;B超监测子宫内膜厚度、卵巢体积、子宫体积变化;子宫内膜病理学改变及卵巢激素水平变化。结果:放置后患者月经量明显减少,血红蛋白值明显升高,放置前血红蛋白水平为98.81±12.22g/L,放置后3,6,12,24个月血红蛋白值分别为116.53±9.62g/L,123.45±7.83g/L,127.26±8.02g/L,129.83±8.34g/L,各组间放置前后差异均有统计学意义(P<0.001);放置前子宫内膜厚度1.52±0.33cm,放置后3,6,12,24个月子宫内膜厚度分别为0.64±0.21cm,0.62±0.14cm,0.56±0.11cm,0.53±0.14cm,各组间放置前后差异均有统计学意义(P<0.001);放置曼月乐后6～12个月,患者子宫内膜病理显示子宫内膜增生过长表现消失,内膜呈分泌现象及间质蜕膜样改变明显;放置前后患者子宫、双侧卵巢体积及雌孕激素水平均无明显变化。结论:放置曼月乐可抑制子宫内膜增长及逆转增生的子宫内膜,副作用少,是治疗子宫内膜增生症安全、有效的方法,值得临床推广。

Objective：To evaluate the curative effect and safety of the levonorgestrel-releasing intrauterine device （Mirena） with progesterone in the treatment of endometrial hyperplasia. Methods：One hundred and fifty one cases of endometrial hyperplasia by pathologic diagnose（ except carcinoma of endometrium）were included, to detect hemglobin increasing, the endometrial thickness, ovarian and uterine volume by ultrasonic ; pathologic changes of endometrial and ovarian hormone before and after the insertion of levonorgestrel-releasing intrauterine devices （Mirena） regularly in twenty-four months. Results： After the insertion of Mirena, hemoglobin of all cases were increased. The hemoglobin before and after the insertion of 3,6,12,24 months were 98.81±12.22 and 116.53 ±9.62,123.45±7.83,127.26±8.02,129.83±8.34g/L. There were significant difference statistically between before and after insertion （P 〈 0. 001 ）. The endometrial thickness before and after the insertion of 3,6,12,24 months were 1.52±0.33 and 0.64±0.21,0.62 ±0.14,0.56±0.11,0.53±0.14cm. There were significant difference statistically between before and after insertion （ P 〈 0.001 ）. Pathological examinations performed 6 - 12 months after the insertion showed that endometrial hyperplasia had reversed in all cases. The endometrium showed visible secretion and pseudo-decidual reaction. There weren＇t significant differences of ovarian, uterine volume and ovarian hormone between before and after insertion. Conclusion：Levonorgestrel-releasing intrauterine device can not only surppress but also reverse the hyperplasia of the endometrial hyperplasia effectively, and side effects are less. So it is an effective and safety therapy in endometrial hyperplasia, and it is worthy to promote the clinical therapy of endometrial hyperplasia.