左炔诺孕酮宫内缓释系统在卵巢子宫内膜异位囊肿术后应用的评价

Evaluation of applying levonorgestrel intrauterine devices after the operation for patients with ovarian endometriotic cysts

目的：探讨卵巢子宫内膜异位囊肿保守性手术后宫腔放置左炔诺孕酮宫内缓释系统（LNG-IUS）的临床价值。方法：选择2006年1月2008年4月在我院施行卵巢子宫内膜异位囊肿剥除术患者90例,分为A、B、C 3组,A组31例（LNG-IUS组）,B组30例（孕三烯酮组）,C组29例（未用药组）。观察比较术前VAS〉3分者治疗后VAS的评分变化,治疗6个月A、B两组FSH、LH和E2水平,治疗1年A、B两组患者对治疗效果满意度并愿继续接受治疗的情况以及治疗费用等。结果：A组治疗3个月和6个月VAS与术前比较有显著差异（P〈0.01）;与B组的差异无统计学意义（P=0.611,P=0.462）;治疗1年A组与B组平均VAS评分无显著差异（P=0.623）,A组与C组的差异有统计意义（P〈0.05）。术后6个月A组E2平均水平正常为85.41±25.73 pmol/L;B组E2明显降低为53.80±16.64 pmol/L,与治疗前的差异有统计学意义（P〈0.05）。治疗1年愿意继续治疗的A组占87%明显高于B组的47%,差异有统计学意义（P〈0.01）;而治疗费用两组无显著差异。结论：LNG-IUS治疗卵巢子宫内膜异位囊肿引起的疼痛有一定的作用,对卵巢功能影响较小,有较好的依从性,可作为卵巢子宫内膜异位囊肿保守手术后的辅助治疗方法。

Objective：To explore the influence factors of placement of levonorgestrel intrauterine devices（LNG-IUS） after the conservative operation in patients with ovarian endometriotic cysts.Methods：Ninety patients,who had received the enucleation of ovarian endometriosis cysts from January of 2006 to April of 2008,were divided into three groups：group A,B and C;group A（the LNG-IUS group） includes 31 patients,while group B（the gestrinone group） and C（the untreated group） covers 30 and 29 patients separately.These groups were selected to observe and make comparison between the following things：score variation of patients,who got a preoperative VAS score〉3 after the treatment;FSH,LH and E2 level in group A and B after 6 months＇ treatment;situation of those patients in group A and B,who were satisfied with the treatment after 1 year＇s treatment,and were willing to continue the treatment;and the treatment cost etc.Results：In group A,significant difference（P〈0.01） exists in VAS score at the end of 3 months and 6 months＇ treatment when compare with the preoperative situation;while group A compares to group B,there was no statistically significant difference（P=0.611,P=0.462）,after one year＇s treatment,there was no significant difference of average VAS score between group A and B,but significant difference exists when comparison was made between group A and C（P〈0.05）.Six months after the treatment,the normal average level of E2 in group A was 85.41±25.73 pmol/L;while in group B,E2 level significantly decreased to 53.80±16.64 pmol/L,compared with the preoperative situation（P〈0.05）;after one year＇s treatment,the proportion of those who were willing to continue the treatment in group A（87%） showed obvious priority than that of group B（47%）,significant difference exists（P〈0.01）.The difference between them was of great significance;there was no obvious difference when it comes to the treatment cost.Conclusion：Intrauterine placement of Mirena may be helpful in the alleviation of the pain caused by ovarian endometriosis cysts,and it has little effect on the ovarian function.Besides,it has good compliance.Therefore,it can be employed in the prevention of ovarian endometriosis cysts after the conservative operation,or it can be used as an accessory therapeutic method to delay the recurrence.