LNG-IUS治疗子宫内膜异位症术后的临床观察

Clinical Study of Levonorgestrel-releasing Intrauterine System in the Treatment of Endometriosis After Conservasive Laparoscopic Surgery

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS)用于子宫内膜异位症(EMs)腹腔镜保守性手术后巩固治疗的临床疗效和不良反应。方法:选择主诉痛经的EMs患者70例,行腹腔镜保守性手术后分为2组,LNG-IUS组35例,促性腺激素释放激素激动剂(GnRHa)组35例。另选取33例术后给予非甾体抗炎药治疗的患者作为对照组。平均随诊14个月,比较治疗前后和3组间痛经视觉模拟评分法(VAS)评分、CA125值及复发率。观察LNG-IUS的不良反应、续用率及患者满意度。结果:LNG-IUS组术后3,6和12个月时VAS评分均较术前明显降低(P<0.05)。术后1年,LNG-IUS组较对照组和GnRHa组VAS评分明显降低(P<0.05)。术后6个月时LNG-IUS组与GnRHa组血清CA125比较差异无统计学意义(P>0.05),与对照组比较明显降低(P<0.05)。术后1年,LNG-IUS组和GnRHa组复发率均显著低于对照组(P<0.05),2组间复发率比较差异无统计学意义(P>0.05)。术后1年LNG-IUS组25.0%的患者有阴道不规则淋漓出血,LNG-IUS续用率94.0%,患者满意度54.5%。结论:LNG-IUS用于EMs腹腔镜保守性手术后的巩固治疗,疗效较好,续用率和患者满意度高。不规则子宫出血是其主要的不良反应。

Objective：To investigate the clinical efficacy and side effects of levonorgestrel-releasing intrauterine system in the treatment of endometriosis（EMs） after conservasive laparoscopic surgery.Methods：seventy women of EMs with complain of dysmenorrhea were recruited,they were devided into two groups,35 women were placed LNG-IUS,35 women were given GnRHa therapy.In addition,33 women of EMs who were given non-steroidal anti-inflammatory drug therapy after surgery were recruited as control group.The average followed up period was 14 months.The mean visual analogue scale（VAS） scores of their dysmenorrhea,serum CA125 levels,recurring rate among the three groups and between pretherapy and post-therapy were compared.Also the side effects of LNG-IUS,the continuation rate and the degree of satisfaction were evaluated.Results：In LNG-IUS group,significant difference（P〈0.05） existed in VAS scores at the end of 3 months,6 months and 1 year treatment when compare with the preoperative situation.After one year＇s treatment,The VAS scores in LNG-IUS group were significantly lower than control group and GnRHa group（P〈0.05） .There was no significant difference（P〈0.05） in serum CA125 between LNG-IUS group and GnRHa group at the end of 6 months treatment,but significant decrease（P〈0.05） existed when comparison was made between LNG-IUS group and control group.After one year＇s treatment,the recurrence rate of LNG-IUS group and GnRHa group were obviously lower than the control group（P〈0.05） ,there was no obvious difference between LNG-IUS group and GnRHa group（P〈0.05） .After one year＇s treatment,there were 25.0% of the patients with irregular uterine bleeding in LNG-IUS group,54.5% of the subjects were very satisfied or satisfied with the treatment,and the continuation rate of LNG-IUS was 94.0%.Conclusions：Placing LNG-IUS as an accessory treatment for patients with EMs after conservasive laparoscopic surgery is effective,with high degree of satisfaction and high continuation.Irregular uterine bleeding is the main side effect.