左炔诺孕酮宫内缓释系统治疗子宫腺肌病远期复发的临床分析

Clinical analysis of long-term recurrence of adenomyosis after levonorgestrel releasing intrauterine system treatment

目的分析左炔诺孕酮宫内缓释系统（LNG—IUS）治疗子宫腺肌病的远期复发情况。方法收集2005年12月至2013年12月在厦门大学附属成功医院诊断为子宫腺肌病，放置LNG—IUS后痛经复发的12例患者的临床资料，分析痛经复发、视觉模拟量表（VAS）评分、子宫增大情况。结果12例患者中，放置LNG—IUS后1、2、3、4年月经量占放置LNG—IUS前月经量的百分比分别为（42±35）％、（36±26）％、（29±18）％、（35±21）％。放置LNG—IUS前和放置后1、2、3、4年VAS评分分别为（8．5±3．2）、（2．0±1．6）、（5．8±2．4）、（7．3±3．2）、（7．9±3．4）分，子宫体积分别为（230±57）、（220±38）、（335±69）、（535±89）、（818±125）cm^3。与放置前比较，放置后1年VAS明显下降（P〈0．05）；放置后3、4年子宫体积明显增加（P〈0．05）。结论采用LNG—IUS保守治疗子宫腺肌病出现远期复发患者，以痛经复发常见，且伴随子宫体积增大。

Objective To evaluate the clinical efficacy of levonorgestrel releasing intrauterine system （LNG-IUS） in treatment of dysmenorrhea associated with adenomyosis and to analyze the long-term recurrence. Methods Clinical data of 12 patients with adenomyosis who were inserted with LNG-IUS and had relapse after 1 year in Xiamen University Chenggong Hospital from December 2005 to December 2013 were collected. The recurrence of dysmenorrheal, visual analogue scale（VAS） scores and hysterauxesis were assessed. Results The percentage of menstrual capacity 1, 2, 3 and 4 years after LNG-IUS insertion for menstrual capacity before LNG-IUS insertion was （42 ±35）% , （36 ±26）% , （29 ± 18）% and （35 ±21）% , respectively. The VAS of dysmenorrhea decreased significantly from （ 8.5 ± 3.2 ） before LNG-IUS insertion to （ 2.0 ± 1.6 ） 1 year after LNG-IUS insertion, and it was （ 5.8 ± 2.4 ） , （7.3 ± 3.2） and （7.9 ± 3.4） scores 2, 3 and 4 years after LNG-IUS insertion. The uterine volume decreased from （230 ± 57）cm^3 before LNG-IUS insertion to （220 ± 38）cm^3 1 year after LNG-IUS insertion, then it increased to （335 ± 69）cm3, （535 ± 89）cm^3 and （818 ± 125 ）cm^3 2, 3, 4 years after LNG-IUS insertion. The VAS of dysmenorrhea increased in 5 cases 2 years after LNG-IUS insertion ; it was in 4 cases 3 years after LNG- IUS insertion and there was 3 eases 4 years after LNG-IUS insertion. The uterus volumes of 12 eases were all in- creased with VAS. Condusions Dysmenorrhea recurrence is common in long-term recurrence of adenomyosis patients after treatment with LNG-IUS insertion. It is always accompanied with the increase of uterus volume.