左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

Effects of levonorgestrel-releasing intrauterine system in the treatment of patients with adenomyosis

目的研究左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病(AM)中的作用。方法对65例临床确诊AM的患者采用宫内放置LNG-IUS治疗。观察术后6个月和12个月后患者的痛经程度、月经量、血红蛋白(Hb)及子宫大小的变化。结果放置LNG-IUS 6个月后,痛经症状明显缓解,VAS评分由(81.3±9.4)分下降到(16.8±12.1)分,差异有统计学意义(P<0.01);放置LNG-IUS后12个月,VAS评分平均为(14.5±16.3)分,与放置前比较,差异有统计学意义(P<0.01)。放置6个月时,65例患者中43例有周期性月经,平均月经量为原来的(25.3±12.2)%(P<0.01)。放置12个月后,62例患者中,25例出现闭经,25例有一过性点滴出血;12例有周期性少量月经。30例合并贫血患者的血红蛋白由(7.3±4.1)g/L上升为(128.9±11.3)g/L,差异有统计学意义(P<0.01)。放置前、放置后6个月、12个月子宫体积大小分别为(182.2±23.0)cm3、(168.7±31.6)cm3和(146.2±36.8)cm3,放置后12个月与放置前比较,差异有统计学意义(P<0.05)。结论 LNG-IUS可缓解子宫腺肌病患者的痛经、减少月经量和缩小子宫体积,具有良好的治疗效果。

Objective To study the efficacy of Levonorgestrel-releasing intrauterine system（LNG-IUS Band name： Mirena） on the treatment of adenomyosis.Methods 65 patients with adenomyosis who received LNG-IUS placement recruited in this study.The visual analogue seale（VAS） scores,menstrual blood volume and uterine volume were compared before and after 6 and 12 months LNG-IUS placement.Results Compared with before treatment,dysmenorrhea was completely relieved or significantly alleviated in all patients after 6 month treatment of LNG-IUS.The mean VAS scores dropped from 81.3±9.4 to 16.8±12.1（P0.01）,the menstrual blood volume reduced significantly [100% vs（25.3±12.2）%,P0.01].After 12 months,hemoglobin recovered to normal in 30 patients with anemia（P0.01）.Uterine volume reduced and had significantly difference compared to before treatment（P0.05）.Conclusions LNG-IUS is an efficient method to treat adenomyosis,it can alleviate dysmenorrheal,decrease menstrual blood volume and reduce uterus volume.