左炔诺孕酮宫内缓释系统控制子宫腺肌病内膜电切术后复发的效果分析

Analysis of the Effects of Levonorgestrel Releasing Intrauterine System on Preventing the Recurrence of Adenomyosis after Transcervical Resection of Endometrium

目的分析子宫腺肌病内膜电切术(TCRE)后放置左炔诺孕酮宫内缓释系统复发的主要因素。方法对168例月经过多伴痛经且要求保留子宫的腺肌病患者,随机分为联合组(子宫内膜电切术+放置左炔诺孕酮宫内缓释系统组)和电切组(子宫内膜电切术组),每组各84例。分别于术后3、12、24、36个月随访痛经(VAS评分)、月经(PBAC评分),B超监测子宫大小,检测CA125等指标。结果术后联合组复发6例,复发率为7.14%。其中术后12个月无复发,术后24个月复发2例,36个月复发4例,4例年龄﹤40岁,占66.67%;电切组复发18例,复发率为21.43%。其中术后12个月复发4例,术后24个月复发6例,术后36个月复发8例,12例年龄﹤40岁,占66.67%。子宫﹥12 w且有明确的腺肌瘤的患者复发10例,占总复发率的41.67%。结论 TCRE联合左炔诺孕酮宫内缓释系统治疗子宫腺肌病能有效降低复发率,减少再手术率,子宫﹥12 w且有明确腺肌瘤的患者应选择其他治疗方法。

Objective To analyze the effects of levonorgestrel releasing intrauterine system on preventing the recurrence of adenomyosis after Transcervical Resection of Endometrium（TCRE）.Methods 168 adenomyosis patients who suffered from dysmenorrhea and menorrhagia were randomized allocated into experimental group and the control group（TCRE only）,with 84 objects each group.Indicators including dysmenorrhea score（VAS）,pictorial blood loss assessment chart（PBAC）,size of uterine measured by B ultrosound and CA125 were followed up 3months,12months,24months and 36months after the operation respectively.Results There were 6 patients in the experimental group who recurred after the operation,the recurrence rate was 7.14%.Numbers of patients with recurrence were 0,2 and 4 respectively at 12 months,24 months and 36 months after operation.And of all the recurrent cases,4 cases were younger than 40 years old,accounting for 66.67%.18 patients recurred in the TCRE group,with the recurrence rate of 21.43%.It appeared 4,6 and 8 recurrent cases at 12 months,24 months and 36 months after operation respectively.And of all the recurrent cases,12 cases younger than 40 years old,accounted for 66.67%.10 patients,whose uterine sizes larger than 12 gestational weeks and with visible adenomyoma,recurred after operation,accounting for 41.67% of the total recurrence number.Conclusion The placement of levonorgestrel releasing intrauterine system after TCRE can degrade the recurrence rate of adnnomyosis.Patients whose uterine size was larger than 12 gestational weeks and with visible adenomyoma should be treated with another therapeutic methods.