GnRH-a联合曼月乐治疗巨大子宫腺肌病的临床分析研究

Clinical analysis of GnRH-a combined with LNG-IUS in the treatment of large adenomyosis

目的探讨GnRH-a联合曼月乐(LNG-IUS)对大子宫腺肌病的治疗效果。方法收集2014年7月至2015年9月因巨大子宫腺肌病于我中心行GnRH-a联合LNG-IUS治疗的患者50例,所有患者应用GnRH-a预处理3针后放环,放环时宫腔深度>9 cm。术后随访12个月,比较上环后不同时间的痛经缓解程度、月经量改变、子宫体积及不良反应。结果 (1)放置LNG-IUS后痛经程度、月经量与放置前相比显著下降,并随放置时间延长呈进一步下降趋势;(2)子宫体积经GnRH-a预处理后显著缩小,放环后子宫体积出现反弹,但仍旧小于预处理前子宫体积,至放环后6~12个月子宫体积趋于平稳;(3)放置LNG-IUS后主要不良反应为阴道点滴出血及腹痛、腰酸。IUD脱落多发生于放环6个月内,与月经量多、子宫体积大有关。结论 GnRH-a联合曼月乐治疗宫腔深度>9 cm的子宫腺肌病具有较好的治疗效果,可显著缓解痛经、减少月经量,值得临床应用。

Objective To investigate the therapeutic effect of GnRH-a combined with levonorgestrel-releasing intrauterine system （LNG-IUS） in the treatment of adenomyosis. Methods From July 2014 to September 2015, fifty patients with large adenomyosis were recruited, whose depth of uterine cavity was larger than 9cm. All patients were inserted LNG-IUS following three courses of GnRH-a. All patients were followed up for 12 months. The scores of pain, menstrual blood volume, uterine volume and adverse reaction were compared to those before therapy. Results （1）After placement of LNG-IUS, scores of pain and the menstrual blood volume had decreased significantly, and further decreasing over time. （2）The uterine volume decreased significantly after pretreated with GnRH-a, which rebounded after placement of LNG-IUS, but still smaller than the volume before pretreatment. The uterine volume tends to be stable after 6 to 12 months. （3）The main adverse reactions were vaginal bleeding, abdominal pain and backache after placing the LNG-IUS. Most of the IUD fall off happened in 6 months, which was associated with large volume of menstrual blood and the big volume of the uterine. Conclusion GnRH -a combined with LNG-IUS is effective in the treatment of adenomyosis when the uterine cavity depth 〉 9 cm, which can significantly alleviate dysmenorrheaand reduce menstrual flow.