GnRH-a联合左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床疗效研究

Clinical Efficacy of GnRHa Combined with Levonorgestrel Intrauterine Sustained Release System in the Treatment of Adenomyosis

目的研究促性腺激素释放激素激动剂(GnRHa)联合左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)治疗子宫腺肌病的临床疗效。方法选择2014年7月至2016年7月于首都医科大学附属北京妇产医院就诊的31例子宫腺肌病患者为研究对象,GnRHa治疗3个月后放置LNG-IUS,观察治疗前及放置LNG-IUS后1个月、3个月、6个月、12个月的痛经程度、月经情况、血红蛋白变化及子宫体积。结果 28例子宫腺肌病患者完成了治疗及随访。28例患者GnRHa治疗后3个月均无月经来潮,无痛经。放置LNG-IUS后3个月、6个月、12个月痛经视觉模拟评分法评分均显著低于治疗前(P<0.05);放置LNG-IUS后3个月血红蛋白显著高于治疗前(P<0.05)。28例患者GnRHa联合LNG-IUS治疗6个月内子宫体积均明显缩小,但放置LNG-IUS后6个月子宫体积较放置LNG-IUS前稍有增大(P<0.05),放置LNG-IUS后6个月、12个月后较放置LNG-IUS 1个月后子宫体积增大(P<0.05)。结论 GnRHa联合LNG-IUS治疗子宫腺肌病可有效缓解患者痛经及经量增多症状,抑制子宫体积持续增大。

Objective To study the clinical effects of gonadotropin-releasing hormone agonist(GnRHa)combined with levonorgestrel intrauterine sustained release system(LNG-IUS,trade name Mirena)in the treatment of adenomyosis.Methods A total of 31 patients with adenomyosis admitted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University between Jul.2014 and Jun.2016 were included in the study.They were placed with LNG-IUS after 3 months treatment of GnRHa.The degree of dysmenorrhea,menstrual status,hemoglobin change and uterine volume of the patients before treatment and 1 month,3 months,6 months and 12 months after placement of LNG-IUS were observed.Results Altogether 28 patients with adenomyosis completed treatment and follow-up.The 28 patients had no menstruation and no dysmenorrhea for 3 months after GnRHa treatment.Visual analogue scale/score(VAS score)in patients with adenomyosis after GnRHa combined with Mirena(3 months,6 months and 12 months)were significantly lower than those before treatment(P<0.05);hemoglobin after 3 months of GnRHa combined with LNG-IUS was significantly higher than that before treatment(P<0.05).The uterine volume of adenomyosis after treatment with LNG-IUS and GnRHa was significantly reduced within 6 months,but the volume of uterus increased slightly 6 months after LNG-IUS placement(P<0.05),after 6 months and 12 months,the uterus volume increased than that at 1 month after LNG-IUS(P<0.05).Conclusion GnRHa combined with LNG-IUS in the treatment of adenomyosis can effectively alleviate the symptoms of dysmenorrhea and menstruation,and inhibit uterine volume increase.