左炔诺孕酮宫内缓释系统预防子宫内膜异位症术后复发的疗效

Efficacy of the Levonorgestrel-releasing Intrauterine System to Prevent Recurrence of Endometriosis after Conservative Surgery

目的探讨左炔诺孕酮宫内缓释系统(LNG-IUS)预防子宫内膜异位症术后复发的安全性及有效性。方法收集2013年1月至2014年12月于中国医科大学附属盛京医院妇产科因中、重度子宫内膜异位症行保守手术治疗的患者。术后按患者治疗意愿将其分为3组:A组,术后单纯应用促性腺激素释放激素激动剂(Gn RH-a)3个周期;B组,术后单纯应用LNG-IUS;C组,术后立即应用Gn RH-a 3个周期,注射第3针当日宫内放置LNG-IUS。所有患者于术后3、6、12、24个月随访,评价痛经缓解程度,同时复查盆腔彩超及血清CA125,明确复发情况。记录所有患者治疗相关不良反应。结果共纳入患者83例,其中A组21例,B组29例,C组33例。术后3个月时,3组患者VAS评分均较术前明显降低(P<0.05)。术后6个月及12个月时,3组VAS评分无统计学差异(P>0.05),术后24个月时,A组VAS评分明显高于其他2组(P<0.05)。至术后24个月,共8例患者子宫内膜异位症复发,其中A组4例(19.05%),B组3例(10.71%),C组1例(3.13%),3组间复发率有统计学差异(P<0.05)。所有患者随访过程中均未发生严重不良反应。结论子宫内膜异位症术后应用LNG-IUS,能有效预防囊肿复发并缓解疼痛,与Gn RH-a联合应用能够进一步提高疗效。

Objective To evaluate the efficacy and safety of tile levonorgestrel-releasing intrauterine system （ LNG-IUS ） for the prevention of endometriosis recurrence after conservative surgery. Methods We enrolled patients with medium and severe endometriosis who underwent conservative surgical treatment. All patients were divided into 3 groups ： group A in which the patients were administered with 3 cycles of gonadotropin-re- leasing hormone agonist （GnRH-a） 5 days postoperatively, group B in which the patients were administered with the LNG-IUS 5 days postoperatively, and group C in which the patients were administered with 3 cycles of GnRH-a 5 days postoperatively and the LNG-IUS on the day of the third GnRH-a injection. All patients were followed up at 3,6,12, and 24 months postoperatively. Dysmenorrhea relief was evaluated, and pelvic ultrasound and serum CA125 detection were performed. All treatment-related adverse reactions were recorded. Results Eighty-three patients were included with 21,29, and 33 in groups A, B, and C, respectively. The VAS scores in all 3 groups after 3 months were significantly lower than those obtained preoperatively （P 〈 0.05）. No significant difference was found in the VAS scores after 6 and 12 months among the 3 groups （P 〉 0.05）. After 24 months, the VAS scores in group A were significantly higher than those in the other 2 groups （P 〈 0.05 ）. Endometriosis recurrence was found in 8 patients after 24 months, with 4 （ 19.05% ）, 3 （ 10.71% ）, and 1 （ 3.13% ） such patient in groups A, B, and C, respectively （ P 〈 0.05 ）. No serious side effects were found. Conclusion Postoperative application of LNG-IUS can effectively prevent recurrence and relieve pain caused by endometriosis, and its combined application with GnRH-a can improve efficacy.