不同时间宫内放置左炔诺孕酮宫内缓释系统对子宫腺肌病患者的疗效分析

Impact of placing levonorgestrel releasing intrauterine system at different times in menstrual cycle on efficacy of adenomyosis

目的探讨放置左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫腺肌病的最佳时机,寻求在达到满意治疗效果的同时,降低治疗副作用的有效方法。方法回顾性分析2002-2014年本院使用曼月乐治疗子宫腺肌病1 372例,按照放置时间分成3组:月经干净后3~7 d(A组)、月经第3~5天(B组)和清宫术后立即放置(C组)。评价放置曼月乐后的疼痛缓解、月经量改变、阴道点滴出血和闭经情况。结果 3组患者放置曼月乐后,疼痛缓解效果和闭经发生率差异无统计学意义(P>0.05);C组比A、B组的月经量减少趋势更明显(P<0.05);3组月经间期阴道点滴出血发生率差异有统计学意义(P<0.05),A、B组的阴道点滴出血的时间更长(P<0.05)。结论月经周期不同时段放置曼月乐均可明显缓解子宫腺肌病引起的痛经,清宫术后放置曼月乐后的激素相关副反应更少,可获取最佳治疗效果。

Objective To investigate the best time for placing the levonorgestrel releasing intrauterine system( brand name: Mirena) in the treatment of adenomyosis in order to achieve the therapeutic efficacy and reduce side effects at the same time. Methods Clinical data of 1 372 women taking Mirena treatment for adenomyosis in our department from the years of 2002 to 2014 were collected and retrospectively analyzed in this study. According to the time for placing Mirena,they were divided into 3 groups,that is,group A( placed in 3- 7 d after menstruation,n = 110),group B( in the 3rd- 5th days during menstruation,n = 1 198) and group C( immediately after abortion/curettage,n = 64). Pain relief,menstrual changes,vaginal spotting and amenorrhea were studied to evaluate the efficacy of Mirena. Results There were no significant differences in pain relief and amenorrhea occurrence among the 3 groups after Mirena placement( P > 0. 05). The patients of group C had an obvious trend in decreased volume of menstrual flow when compared with those of group A and group B( P < 0. 05). The incidence of intermenstrual vaginal bit bleeding were significant different among the 3 groups( P < 0. 05),and the patients of groups A and group B had remarkably longer vaginal spotting( P < 0. 05). Conclusion Placing Mirena in different periods of menstrual cycle can alleviate the dysmenorrhea caused by adenomyosis. And the placement immediately after abortion /curettage can reduce the hormone relative adverse reactions,and achieve better efficiency.