子宫内膜异位症保守性手术联合药物巩固后复发者应用左炔诺孕酮宫内缓释系统的疗效观察

Effect observation of the use of levonorgestrel-releasing intrauterine system in the treatment of recurrence of endometriosis after consolidation of conservative surgery combined with drug

目的探讨左炔诺孕酮宫内缓释系统在子宫内膜异位症保守性手术及联合药物治疗后复发患者中的应用效果。方法选取2011年5月~2014年7月在本院妇产科住院治疗的68例子宫内膜异位症手术及联合药物治疗复发患者作为研究对象,给予左炔诺孕酮宫内缓释系统进行治疗。随访12个月,观察其治疗效果。结果置入LNG-IUS后3、6、12个月的VAS评分、血清CA125水平显著低于置入前,血红蛋白水平显著高于置入前,差异有统计学意义（P〈0.05）。置入LNG-IUS后6、12个月的盆腔肿块体积显著小于置入前,差异有统计学意义（P〈0.05）。放置LNG-IUS后,随着置入时间的增加,患者的子宫内膜厚度逐渐变薄,月经量逐渐减少,与置入前比较,差异有统计学意义（P〈0.05）。接受LNG-IUS治疗3个月后的经间期出血发生率为66.2%,随着时间推移,下腹坠痛、经间期出血以及面部色素沉着等不良反应发生率逐渐降低,差异有统计学意义（P〈0.05）。LNG-IUS脱落以及闭经发生率较低,不同时间段比较,差异无统计学意义（P〉0.05）。结论左炔诺孕酮宫内缓释系统治疗术后复发性子宫内膜异位症效果显著,值得临床推广应用。

Objective To explore the application effect of levonorgestrel-releasing intrauterine system（LNG-IUS） in patients with recurrent endometriosis after treatment of conservative operation combined with drug. Methods 68 patients with recurrent endometriosis after treatment of conservative operation combined with drug in our hospital from May 2011 to July 2014 were selected as the research group,all patients were given LNG-IUS for treatment and followed up for 12 months,the therapeutic effect was observed. Results The score of VAS,the level of serum CA125 at 3,6,12 months after placement of LNG-IUS was lower than that before placement of LNG-IUS,the level of hemoglobin at3,6,12 months after placement of LNG-IUS was higher than that before placement of LNG-IUS,with significant difference（P〈0.05）.The volume of pelvic mass at 6,12 months after placement of LNG-IUS was less than that before placement of LNG-IUS,with significant difference（P〈0.05）.After placement of LNG-IUS,with the increase in placement time,the endometrial thickness were gradually thinning,menstrual volume was gradually reduced,compared with the before placement,the difference was statistically significant（P〈0.05）.The incidence rate of intermenstrual bleeding after treatment of LNG-IUS at 3 months was 66.2%.The incidence rate of adverse reaction such as bearing-down pain,intermenstrual bleeding,and facial pigmentation were gradually reduced along time,the difference was statistically significant（P〈0.05）.The incidence rate of amenorrhoea and LNG-IUS fall-off was low,there was no significant difference in different time periods（P〉0.05）. Conclusion LNG-IUS has favorable effect in patients with postoperative recurrent endometriosis,it is worthy of clinical promotion and application.