子宫内膜切除联合LNG-IUS治疗子宫腺肌病的临床疗效

Clinical observation on hysteroscopic transcervical resection of endometrium combined with levonorgestrel-releasing intrauterine system in treatment of adenomyosis

目的观察宫腔镜子宫内膜切除(TCRE)联合左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病的临床疗效和可行性。方法收集2009年1月至2011年1月,我院收治62例无生育要求且预保留子宫的腺肌病患者,将其随机分为观察组和对照组,每组31例。对照组单纯放置LNG-IUS治疗,观察组给予TCRE联合LNG-IUS治疗。观察2组患者在LNG-IUS放置前及放置后1、3、6、12个月的月经量、疼痛视觉模拟(VAS)评分、子宫体积、血清CA125、生殖激素水平,记录2组不良反应发生情况。结果放置LNG-IUS后,2组患者月经过多症状均明显改善,CA125水平均明显降低,且观察组均显著优于对照组(P<0.05);2组的VAS评分均明显降低,但组间无显著差异(P>0.05)。2组患者的子宫大小、血清FSH、LH、E2及P水平在放置LNG-IUS前后均未见明显改变,组间比较也未见显著差异(P>0.05)。结论 TCRE联合LNG-IUS治疗子宫腺肌病疗效显著,可以有效防止单纯放置LNG-IUS引起的淋漓出血,安全性好,是一种有效的保守治疗方法。

Objective To observe the effects of hysteroscopic transcervical resection of endometrium combined with levonorgestrel-releasing intrauterine system in the treatment of adenomyosis. Methods Clinical data of 62 cases with adenomyosis from January 2009 to January2011 were randomly divided into 2 groups with 31 cases each. The observation group was given hysteroscopic transcervical resection of endometrium（ TCRE） combined with levonorgestrel-releasing intrauterine system（ LNG-IUS）,the control group was given LNG-IUS. All patients were followed up in 0,1,3,6,12 months after treatmenting with LNG-IUS. The menstrual blood volume,score of VAS,volume of uterus,CA125 and the levels of serum reproductive hormone were analyzed before treatment and after treatment. Results After the therapy,the curative effects of controlling menorrhea were improved and the the observation group was significantly better than the control group（ P〈0. 05）.The VAS scores were significantly decreased after the therapy in the two groups,but there was no significant difference between the two groups（ P〈0. 05）. The level of CA125 in the observation group was significantly lower than the pretherapy,which was better than that in the control group（ P〈0. 05）. There was no significant difference between the two groups in the volume of uterus after treatment and the levels of serum FSH,LH,E2 and P（ P〉0. 05）. Conclusion It is exact effect to treat adenomyosis by TCRE combined with LNG-IUS,which can prevent dripping bleeding induced by application of LNG-IUS effectively.