左炔诺孕酮宫内缓释系统治疗子宫腺肌病中远期临床观察

Mid-and long-term effect of levonorgestrel-releasing intrauterine system on adenomyosis

目的观察子宫腺肌病（AM）患者放置左炔诺孕酮宫内缓释系统（LNG-IUS）后的中远期临床疗效和安全性。方法对36例子宫腺肌病患者放置LNG-IUS,记录放置前1个月、放置后第1~5年的痛经评分、月经量、子宫内膜厚度变化,同时阴道超声测量子宫及双侧卵巢体积并抽取晨血查生殖激素水平、血红蛋白含量、血清CA125水平及肝功能、血脂代谢等各项指标。结果 LNG-IUS治疗子宫腺肌病第1~5年内,痛经、月经量多等症状改善显著,血红蛋白水平迅速提高,贫血纠正,血清CA125水平降低,一定程度上缩小了子宫体积且内膜厚度明显变薄,有效控制子宫腺肌病的病程进展,治疗期间双侧卵巢体积无明显变化,对患者肝功能、血脂代谢及性激素分泌无明显影响。中远期的不良反应主要为阴道少量点滴出血,患者多能耐受。结论宫内放置LNG-IUS用于治疗子宫腺肌病是一种长效稳定、经济安全的保守性治疗方法,具有良好的中远期效果。

Objective To investigate the mid-and long-term outcomes and safety of inserting levonorgestrel-releasing intrauterine system/device（LNG-IUS） in patients with adenomyosis（AM）.Methods LNG-IUS was used in 36 AM patients and the clinical data were kept regarding the scores of dysmenorrheal,menstrual blood volume and variation of endometrium 1 month before the insertion and the 1st to 5th year of the device setting,respectively,besides measuring the size of uterus and bilateral ovaries by transvaginal ultrasonography,determining the levels of reproductive hormone,hemoglobin,serum CA125,hepatic function and lipoprotein by morning blood test.Results Within the 1st to the 5th year of the management of AM by LNG-IUS,dysmenorrheal and menorrhagia improved significantly,with immediately elevated hemoglobin,management of anemia and reduced CA125,and the size of the uterus became shrunk and endometrium appeared thinned to a certain degree,which led to excellent management of the progress of AM.The sizes of bilateral ovaries remained as usual during the therapy and the treatment produced no significant effect on the hepatic function,lipoprotein and hormone secretion.Though minor vaginal bleeding was found as the major mid-and long-term adverse effect,all patients could virtually be tolerant.Conclusion LNG-IUS may have mid-and long-term outcomes in AM concerning its stability,economy,safety and means of conservative therapy.