左炔诺孕酮宫内缓释系统治疗子宫腺肌症临床观察

Clinical observation of levonorgestrel-releasing intrauterine system in the treatment for adenomyosis

【目的】探讨左炔诺孕酮宫内缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)治疗子宫腺肌症的有效性及安全性。【方法】我们对应用LNG-IUS治疗子宫腺肌症57例患者进行术后1、3、6和12个月随访,主要比较内容:PBAC评分、痛经评分、血红蛋白、生活质量(QOL)评分包括躯体成分(PCS)评分和精神成分(MCS)评分、月经影响评分、子宫体积。【结果】随访患者术前及术后1、3、6、12个月的PBAC评分逐渐减少,分别为(278.79±62.86)分、(71.21±17.41)分、(52.51±13.28)分、(35.35±9.31)分和(6.88±4.90)分(P<0.05);痛经评分逐渐下降,分别为(5.05±1.31)分、(3.47±1.50)分、(2.68±1.00)分、(2.00±1.05)分和(1.58±1.07)分(P<0.05);血红蛋白HB水平逐渐提高,分别为(84.37±5.07)、(93.47±5.36)、(104.96±5.24)、(115.07±5.08)、(120.74±4.34)g/L(P<0.05);性激素水平FSH、LH和E2术后较术前无明显变化(P<0.05);术前及术后6、12个月QOL评分中:PCS评分逐渐提高,分别为(36.04±5.29)分、(49.21±4.16)分和(54.79±2.55)分(P<0.05);MCS评分逐渐提高,分别为(44.84±7.00)分、(53.44±4.24)分和(57.68±2.98)分(P<0.05);术前及术后6、12个月月经影响评分术后较术前下降(P<0.05)。【结论】LNG-IUS治疗子宫腺肌症安全有效,既能有效减少月经量和缓解痛经,又能纠正贫血和提高患者生活质量,且无严重不良反应。

[Objective]To investigate the effectiveness and safety of levonorgestrel-releasing intrauterine system （LNG-IUS） in the treatment for adenomyosis. [ Methods ] A total of 57 patients with adenomyosis were treated with LNG-IUS and followed up on the 1, 3, 6 and 12 months after the operation. PBAC score, menorrhalgia score, hemoglobin, QOL （including PCS and MCS）, menstruation score and uterus volume were compared. [Results] The PBAC scores decreased gradually before the operation and on the 1, 3,6 and 12 months after the operation [（278.79 ± 62.86） points, （71.21 ± 17.41） points, （52.51 ± 13.28） points, （35.35 ± 9.31） points and （6.88 ± 4.90） points]（P〈0.05）. Menorrhalgia scores also decreased gradually [（5.05 ±1.31） points, （3.47±1.50） points, （2.68± 1.00） points, （2.00 ±1.05） points and （1.58 ±1.07） points]（P〈0.05）. Hemoglobin increased gradually [（84.37 ± 5.07） g/L, （93.47 ± 5.36） g/L, （104.96 ± 5.24） g/L, （115.07 ±5.08） g/L and （120.74 ± 4.34） g/L]（P〈0.05）. Compared with those before the operation, the levels of FSH, LH and E2 changed a little（P〈0.05）. As for QOL scores before the operation and on the 6 and 12 months after the operation, PCS score inereased gradually [（36.04 ± 5.29） points, （49.21 ± 4.16） points and （54.79 ± 2.55） points]（P〈0.05）; MCS seore also increased gradually [（44.84 ± 7.00） points, （53.44 ± 4.24） points and （57.68 ± 2.98） points]（P〈0.05）. According to menstruation score before the operation and on the 6 and 12 months after the operation, the median decreased. [Conclusion] LNG-IUS in the treatment for adenomyosis is safe and effec- tive. It can not only reduce the menstrual blood volume and menorrhalgia, but also cure the anemia and improve the quality of life with- out severe adverse reactions.