左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜电切术治疗围绝经期异常子宫出血的临床疗效及安全性评价

Clinical efficacy and safety of levonorgestrel intrauterine birth control system combined with hysteroscopic abnormal endometrial electrotomy in the treatment of abnormal uterine bleeding in perimenopausal period

目的探讨在临床中使用左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜电切术的方法治疗围绝经期异常子宫出血的临床疗效与安全性。方法回顾性分析2017年5月至2019年5月上海交通大学医学院附属瑞金医院妇科诊疗的100例围绝经期异常子宫出血患者的病例资料。根据治疗方法的不同分为观察组和对照组,各50例。对照组患者在治疗中口服地屈孕酮结合诊断性刮宫,观察组应用左炔诺孕酮宫内节育系统联合宫腔镜子宫内膜电切术的方法。比较2组患者治疗后1、3、6、12个月的有效率、月经失血图(PBAC)评分以及不良反应发生情况。结果①治疗后1、3、6、12个月,观察组总有效率(100%、100%、98.0%、90.0%)明显高于对照组(94.0%、96.0%、80.0%、76.0%),差异有统计学意义(P<0.05);②治疗后1、3、6、12个月时观察组PBAC评分为(61.15±6.35)、(45.63±4.56)、(26.65±4.72)、(24.83±3.91)分,均明显低于对照组[(70.59±8.91)、(58.75±7.31)、(39.24±5.62)、(37.42±4.20)分)],差异有统计学意义(P<0.05)。③观察组患者中不良反应发生率(6.0%)明显低于对照组(18.0%),差异有统计学意义(P<0.05)。结论为围绝经期异常子宫出血患者选择治疗方法时,可采取左炔诺孕酮宫内节育系统和宫腔镜子宫内膜电切术相结合的方法,疗效确切,安全性更高,且能明显降低出血量。

Objective The current clinical efficacy and safety of levonorgestrel intrauterine system combined with hysteroscopic endometrial resection in the treatment of perimenopausal abnormal uterine bleeding.Methods Through retrospective analysis,the medical records of 100 patients with perimenopausal abnormal uterine bleeding who were diagnosed and treated by the Department of Gynecology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine from May 2017 to May 2019 were analyzed.According to different treatment methods,they were divided into observation group and control group,each with 50 cases.The control group received oral dydrogesterone combined with diagnostic curettage,and the observation group used levonorgestrel intrauterine contraceptive system combined with hysteroscopic endometrial resection.Compare the effective rate,menstrual blood loss chart(PBAC)scores of 1 month,3 months,6 months,and 12 months after treatment and adverse reactions between the two groups of patients after 1 year of treatment.Results①After 1,3,6,and 12 months treatment,the total effective rate(100%,100%,98.0%,90.0%)of the observation group was significantly higher than that of the control group(94.0%,96.0%,80.0%,76.0%),and the difference was significant(P<0.05);②PBAC scores at 1 month,3 months,6 months,and 12 months after treatment in the observation group were(61.15±6.35),(45.63±4.56),(26.65±4.72),(24.83±3.91)points,which were significantly lower than those of the control group[(70.59±8.91),(58.75±7.31),(39.24±5.62),(37.42±4.20)points)],the differences were significant(P<0.05).③The incidence of adverse reactions in the observation group(6.0%)was significantly lower In the control group(18.0%),the difference was significant(P<0.05).Conclusion When choosing treatment methods for patients with abnormal uterine bleeding during perimenopausal period,a combination of levonorgestrel intrauterine system and hysteroscopic endometrial resection can be adopted,which has definite curative effect,higher safety,and obvious effect Reduce bleeding.