依托孕烯皮埋剂与左炔诺孕酮治疗子宫腺肌病的对比研究

Comparative study of etopotene and levonorgestrel in the treatment of adenomyosis

目的:比较观察依托孕烯皮埋剂与左炔诺孕酮宫内缓释系统治疗子宫腺肌病的效果及不良反应,探讨子宫腺肌病的治疗新方法。方法:选择门诊给予依托孕烯皮下埋植治疗的子宫腺肌病病人30例作为观察组,采用左炔诺孕酮宫内缓释系统治疗的子宫腺肌病病人30例作为对照组,观察比较2组病人治疗后的痛经程度、月经量、子宫体积变化,同时观察2组病人治疗后月经模式及激素相关不良反应的发生情况。结果:治疗前,2组病人痛经评分差异无统计学意义(P> 0. 05);治疗后1～12个月,2组病人各时间点痛经评分均逐渐降低(P <0. 01)。治疗1个月和6个月时,2组间痛经评分差异有统计学意义(P <0. 05和P <0. 01)。2组治疗后1个月月经量均减少(P <0. 05),术后12个月对照组月经量减少更明显(P <0. 05)。2组治疗后3个月与治疗前比较子宫体积均有缩小(P <0. 05),2组治疗效果无明显差异(P> 0. 05)。2组体质量增加及痤疮、乳房肿痛不良反应发生率差异无统计学意义(P> 0. 05),月经模式差异有统计学意义(P <0. 05),观察组经期延长、月经频发更多见。结论:依托孕烯皮埋剂与左炔诺孕酮宫内缓释系统都能够治疗子宫腺肌病,二者治疗效果相当,但依托孕烯皮埋后经期延长、月经频发发生率高,在治疗子宫腺肌病方面,依托孕烯可作为不宜放置左炔孕酮宫内缓释系统的替代方法。

Objective: To compare the clinical efficacy and untoward effect between etonogestrel implant and levonorgestrel-releasing intrauterine system( LNG-IUS) in the treatment of adenomyosis,and provide a new treatment method for adenomyosis. Methods: Thirty adenomyosis patients treated with etonogestrel implant and 30 adenomyosis patients treated with LNG-IUS were divided into the observation group and control group,respectively. The dysmenorrheal degree,menstrual blood volume,volume of uterus,menstrual pattern and hormone-related adverse reactions between two groups were compared after treatment. Results: The difference of the score of dysmenorrheal between two groups was not statistically significant before treatment( P > 0. 05),and the scores of dysmenorrheal in two groups at each time-point gradually decreased after 1 to 12 months of treatment( P < 0. 01). At 1 and 6 months of treatment,the differences of the scores of dysmenorrheal between two groups were statistically significant( P < 0. 05 and P < 0. 01). The menstrual blood volume in two groups decreased after 1 month of treatment( P < 0. 05),and the decreasing degree of which in control group was more obvious at 12 months of treatment( P < 0. 05). Compared with before treatment,the uterine volume in two groups decreased after 3months of treatment( P < 0. 05),and the difference of the treatment effect between two groups was not statistically significant( P >0. 05). The differences of the body mass increasing,and incidence rates of acne and breast swelling pain between two groups were not statistically significant( P > 0. 05). The difference of menstrual pattern between two groups was statistically significant( P < 0. 05),and the menstrual period prolonging and frequence of menstrual cycle increasing were more common in observation group. Conclusions: Both etonogestrel implant and LNG-IUS can be used to treat adenomyosis,and the effect between two methods is similar. After etonogestrel implant,the menstrual period prolonging and frequency of menstruation increasing are common. In the treatment of adenomyosis,the etonogestrel implant can be used as an alternative to the intrauterine sustained-release system of LNG-IUS.