左炔诺孕酮宫内缓释剂在围绝经期女性中的应用

Application of an intrauterine system for controlled release of levonorgestrel in perimenopausal women

目的 探讨左炔诺孕酮宫内缓释剂在围绝经期女性中的临床应用和疗效. 方法 选取在北京医院放置左炔诺孕酮宫内缓释剂的围绝经期患者105例,年龄42～53岁,平均（45.8±2.9）岁.对其放置原因、临床治疗效果及不良反应进行回顾性分析. 结果 患者的疾病类型为月经量过多25例（23.8％）,痛经38例（36.2％）,月经量多合并痛经16例（15.2％）,卵巢巧克力囊肿剥除术后联合GnRH-a类药物治疗9例（8.6％）,子宫内膜单纯型增生13例（12.4％）,子宫肌瘤合并全身系统疾病4例（3.8％）.月经量过多贫血患者中,手术前后血红蛋白水平分别为（99.4±19.1）g/L与（123.3±24.5）g/L,差异有统计学意义（P＜0.01）.术前痛经评分（5.9±1.0）分,与术后6个月（3.0±0.7）分比较,差异有统计学意义（P＜0.05）.子宫内膜异位症、卵巢巧克力囊肿患者12个月影像学均未发现附件区包块.子宫内膜单纯型,增生患者12个月后诊断性刮宫,子宫内膜病理均转归正常,有效率100％.无不良反应发生. 结论 左炔诺孕酮宫内缓释剂可用于治疗围绝经期女性月经量过多,缓解痛经,治疗子宫内膜单纯型增生,预防卵巢巧克力囊肿的复发.

Objective To investigate the effect of an intrauterine system for controlled release of levonorgestrel （LNC-IUS） in perimenopausal women.Methods A total of 105 perimenopausal patients （aged from 42 53 years with a mean age of 45.8±2.9 years） treated with LNGr-IUS in Beijing Hospital were enrolled in this study.Retrospective analysis concerning reasons for device placement,clinical effects and adverse reactions was conducted.Results Of the patients,25 （23.8％） had menorrhagia,38 （36.2％） had dysmenorrhea,16 （15.2％） had a combination of menorrhagia and dysmenorrhea,9 （8.6％） had undergone cystectomy for endometriosis followed by gonadotropinreleasing hormone-analogue （GnRH-a） therapy,13 （12.4 ％） had simple endometrial hyperplasia,and 4 （3.8％） had leiomyoma combined with systemic disorders.A statistical difference in the average hemoglobin level was found in menorrhagia patients with anemia before and after treatment [（99.4 ±19.1） g/L vs.（123.3±24.5） g/L,P＜0.01].Dysmenorrhea symptom scores decreased six months after treatment[（5.9± 1.0） vs.（3.0±0.7）],P＜0.05）.No adnexal masses were found on Bultrasound 12 months after treatment in patients who had undergone cystectomy for endometriosis.For patients with simple endometrial hyperplasia,diagnostic dilation and curettage 12 months after treatment showed normal endometrial morphology,with a total effectiveness rate of 100％.No adverse reactions were found.Conclusions The intrauterine levonorgestre[-releasing system is effective in the treatment of menorrhagia,dysmenorrhea and simple endometrial hyperplasia,and can prevent the recurrence of endometriotic cyst in perimenopausal women.