固定式左炔诺孕酮宫内缓释系统用于曾有本系统下移或脱落患者的临床观察

Fixation of levonorgestrel-releasing intrauterine system prevents its expulsion or malposition

目的左炔诺孕酮宫内缓释系统(LNG-IUS)是治疗子宫腺肌症的一线方案,缺点是高下移/脱落率;本研究将LNG-IUS改良并固定于子宫肌层,观察其脱落率,有效性,副作用。方法选取2014年1月至2018年3月就诊于本院的41例曾有LNG-IUS下移或脱落的子宫腺肌症的患者为观察组给予放置改良LNG-IUS,同期41例应用GnRH-a后放置原装LNG-IUS患者为对照组。比较两组间的脱落率以及随访一年后的痛经程度(VRS)、子宫体积等指标。结果观察组2例患者分别于放置后的12、18个月后排出,3年总脱落率4.9%;对照组为19.5%(χ^(2)=4.100,P=0.043);观察组其余39例患者在观察期内均位置居中,无环异位及感染;两组内1年末痛经程度、月经量(PBAC)、子宫体积、血红蛋白比较均较未治疗前明显差异(P <0.01);两组间1年末各指标比较差异无统计学意义(P> 0.05)。结论将固定式LNG-IUS植入于曾有IUS脱落/下移患者,是一种较安全有效且经济简便的的降低LNG-IUS下移或脱落率的方法。

Objective As a primary solution to the adenomyosis,the levonorgestrel-releasing intrauterine system(LNG-IUS)is clinically vitiated for its high rate of expulsion/downward displacement.This study aimed to study the expulsion/malposition rate,effectiveness,and side effects by modifying the LNG-IUS and anchoring it into the myometrium.Methods A total of 41 patients with adenomyosis who had LNG-IUS downward displacement/expulsed visiting our hospital January 2014 to March 2018 were enrolled as the experimental group and treated with the modified LNG-IUS,while another 41 patients during the same period,as the control group,were treated with LNG-IUS after GnRH-αtreatment.Results Among the experiment group,the modified system in 2 patients were expulsed respectively at months 12 and 18 after anchoring,with a total expulsion rate of 4.9%in 36 months.In the control group the total expulsion rate was 19.5%,with significant difference between the groups(χ^(2)=4.100,P=0.043).In the experiment group,the LNG-IUS positions in the 39 patients without expulsion were properly fixed in uterus without ectopic displacement and infection during observation period.As compared with pretreatment,the differences of both groups were statistically significant within one year treatment in terms of the degree of dysmenorrhea(VRS score),menstrual volume(PBAC score),uterine volume and hemoglobin(all P>0.05).Conclusion The Modified LNG-IUS is safe,effective,economical and simple in reducing the rate of LNG-IUS expulsion/downward displacement in adenomyosis patients with expulsion or malposition of LNG-IUS.