左炔诺孕酮宫内缓释系统对子宫肌瘤的影响

Effect of Levonorgestrel-releasing Intrauterine System on Uterine Fibroids

目的:评估左炔诺孕酮宫内缓释系统在治疗合并有子宫肌瘤的子宫腺肌症时对子宫肌瘤产生的影响。方法:选取2016年1月-2017年12月于本院就诊的25~50岁子宫腺肌症的绝经前妇女,使用随机化序列方法抽取样本36例作为研究对象。观察比较放置LNG-IUS前及放置后6、12个月后36例患者的子宫出血模式及子宫参数。结果:放置LNG-IUS6个月后,月经过多患者的数量从放置前的41.67%(15/36)逐渐下降至0。此外,放置6个月后与12个月后比较,发现月经淋漓不净的患者逐渐减少。在研究过程中出现月经过少的患者增加,放置12个月后共有30.56%(11/36)的患者出现月经过少。放置6、12个月后患者的PBAC评分中位数与放置前比较均明显下降;且在评估中,36例患者的血红蛋白中位数与放置前比较均显著增加;子宫内膜厚度与放置前比较均明显下降,差异均有统计学意义(P<0.05)。放置6、12个月后患者的子宫体积较放置前均明显缩小,差异有统计学意义(P<0.05);子宫肌瘤体积有变化,但差异无统计学意义(P>0.05)。放置6和12个月后,患者的痛经程度均明显减轻,同时其活动能力丧失点及痛经分级均有所改善,差异均有统计学意义(P<0.05)。结论:左炔诺孕酮宫内缓释系统能够有效治疗子宫腺肌症,且对子宫肌瘤几乎无影响。

To evaluate the effect of levonorgestrel-releasing intrauterine system on uterinefibroids in the treatment of adenomyosis complicated with uterine fibroids.Method:A total of36premenopausalwomen with adenomyosis of25-50years old who were admitted to our hospital from January2016to December2017were selected as the study objects by random sequence method.The uterine bleeding pattern and uterineparameters of36patients were observed and compared before and after6and12months LNG-IUS placement.Result:After LNG-IUS placement6mouths,the number of patients with menorrhagia gradually decreased from41.67%(15/36)before placement to0.In addition,after placement6months was compared with after12months,the patients with menstruation dripping dirty gradually decreased.There was an increase in the number of patients with menstrual disorder during the study,with30.56%(11/36)of those who had experienced menstrual disorder after placement12months.After6and12months of placement,the median PBAC scores of the patients was significantly lower than that before placement;the median hemoglobin of36patients was significantly higher than that before placement at assessment;the thickness of endometrium decreased significantly compared with that before placement,the differences were statistically significant(P<0.05).After placement6and12months,the uterine volume of the patients was significantly smaller than that before placement,the difference was statistically significant(P<0.05);the volume of uterine fibroids was changed,but the difference was not statistically significant(P>0.05).After placement6and12months,the degree of dysmenorrhea was significantly alleviated,and the locomotor activity loss point and dysmenorrhea grading were improved,the differences were statistically significant(P<0.05).Conclusion:Levonorgestrel-releasing intrauterine system is effective in the treat of adenomyosis and has little effect on uterine fibroids.