左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜切除术治疗围绝经期异常子宫出血的临床疗效

Clinical efficacy of levonorgestrel intrauterine system in combination with hysteroscopic surgery for peri-menopausal abnormal uterine bleeding

目的探讨左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜切除术治疗围绝经期异常子宫出血的临床疗效。方法选取2017年1月至2018年6月东阳市中医院诊治的围绝经期异常子宫出血患者146例作为研究对象。随机分为观察组和对照组,各73例;两组患者均采取左炔诺孕酮宫内节育系统治疗,观察组联合宫腔镜子宫内膜切除术。随访12个月,比较两组患者不同时间点的月经失血图(PBAC)评分、子宫内膜厚度、子宫体积,以及血红蛋白、血清糖类抗原125(CA125)水平,比较有效率,观察复发率和不良反应发生情况。结果两组患者在治疗前PBAC评分上差异无统计学意义(P>0.05);观察组治疗后1个月、3个月、6个月、12个月PBAC评分均较治疗前明显降低,与对照组比较,差异均具有统计学意义(P<0.05)。两组患者在治疗前子宫内膜厚度、子宫体积上差异均无统计学意义(P>0.05);观察组治疗后6个月、12个月的子宫内膜厚度、子宫体积均较治疗前明显减小,与对照组比较,差异均具有统计学意义(P<0.05)。两组患者在治疗前血红蛋白、CA125水平上差异无统计学意义(P>0.05);观察组治疗后6个月、12个月的血红蛋白均较治疗前明显升高,CA125水平均较治疗前明显降低,与对照组比较,差异均具有统计学意义(P<0.05)。观察组治疗后1个月、3个月、6个月、12个月的有效率均明显高于对照组,差异均具有统计学意义(P<0.05);观察组复发率和不良反应发生率均明显低于对照组,差异均具有统计学意义(P<0.05)。结论左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜切除术治疗围绝经期异常子宫出血患者,其临床疗效确切、安全可靠,在控制病情、减少复发和不良反应发生方面均具有优势,值得临床推广应用。

Objective To investigate the clinical efficacy of levonorgestrel intrauterine system in combination with hysteroscopic surgery for patients with peri-menopausal abnormal uterine bleeding.Methods 146 patients with abnormal uterine bleeding during peri-menopausal period in Dongyang Hospital of Traditional Chinese Medicine from January 2017 to June 2018 were selected as research objects.They were randomly divided into control group and observation group,with 73 cases each.The control group was treated with levonorgestrel intrauterine system,and the observation group was treated with levonorgestrel intrauterine system combined with hysteroscopic surgery.All the patients were followed up for 12 months,the Pictorial Blood Loss Assessment Chart(PBAC)score,endometrial thickness,uterine volume,hemoglobin,serum carbohydrate antigen 125(CA125)level,effective rate,recurrence rate and incidences of adverse reactions were observed.Results There was no significant difference in the PBAC score between the two groups before treatment(P>0.05);the PBAC scores of the observation group at a month,3 months,6 months and 12 months after treatment were significantly lower than those before treatment,all with statistically significant differences between the two groups(P<0.05).There was no significant difference in the thickness of endometrium and uterus volume between the two groups before treatment(P>0.05);the endometrial thickness and uterine volume of the observation group were significantly decreased at 6 months and 12 months after treatment compared with those before treatment,with statistically significant differences between the two groups(P<0.05).There was no significant difference in the levels of hemoglobin and CA125 between the two groups before treatment(P>0.05);the hemoglobin levels were significantly increased and the CA125 level was significantly decreased at 6 months and 12 months after treatment compared to those before treatment in the observation group,with statistically significant differences between the two groups(P<0.05).The effective rate of the observation group at a month,3 months,6 months and 12 months after treatment was significantly higher than that of the control group respectively,with statistically significant differences(P<0.05).The recurrence rate and incidence of adverse reaction in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).Conclusions The clinical efficacy of levonorgestrel intrauterine system and hysteroscopic surgery in the treatment of patients with perimenopausal abnormal uterine bleeding is safe and reliable,with advantages in reducing recurrence and adverse reactions,which is worthy of clinical application.