子宫内膜消融术联合左炔诺孕酮宫内节育系统治疗子宫腺肌症月经过多的效果分析

Efficacy of Endometrial Ablation Combined with Levonorgestrel Intrauterine System in the Treatment of Menorrhagia in Adenomyosis

目的:探讨子宫内膜消融术联合左炔诺孕酮宫内节育系统(LNG-IUS)在子宫腺肌症月经过多患者中的应用价值。方法:选择2017年4月-2019年4月江西省妇幼保健院收治的60例子宫腺肌症月经过多患者,按随机数字表法将其分为对照组(30例)和研究组(30例)。对照组单纯放置LNG-IUS,研究组采用子宫内膜消融术联合LNG-IUS治疗,两组均于术后12个月评估效果。比较两组临床疗效、月经量变化情况[月经失血图(PBAC)评分]、痛经程度[视觉模拟评分法(VAS)评分]、子宫内膜厚度、癌抗原125(CA125)水平、血清性激素[促卵泡激素(FSH)、黄体生成激素(LH)、雌激素(E)、孕酮(P)]水平、不良反应。结果:研究组治疗总有效率为93.33%,高于对照组的73.33%,差异有统计学意义(P<0.05)。术后12个月,研究组PBAC评分、VAS评分、子宫内膜厚度、CA125水平分别为(39.26±8.40)分、(1.94±0.62)分、(5.38±0.92)mm、(30.45±5.20)kU/L,低于对照组的(51.98±15.41)分、(2.89±0.75)分、(6.91±1.03)mm、(58.91±7.12)kU/L,差异均有统计学意义(P<0.05)。术后12个月,研究组FSH、LH、E、P分别为(10.95±1.13)IU/L、(10.15±2.08)IU/L、(0.37±0.06)nmol/L、(0.83±0.11)nmol/L,均高于对照组的(8.67±0.92)IU/L、(6.57±1.02)IU/L、(0.28±0.04)nmol/L、(0.62±0.14)nmol/L,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:子宫内膜消融术联合LNG-IUS能够有效减少子宫腺肌症患者月经量,缓解痛经,促进子宫内膜萎缩,且对血清性激素水平影响较小,安全可行,值得临床推广应用。

Objective:To investigate the application value of endometrial ablation combined with levonorgestrel intrauterine system (LNG-IUS) in patients with adenomyosis and menorrhagia.Method:A total of 60 patients with adenomyosis menorrhagia who were admitted to Jiangxi Provincial Maternal and Child Health Hospital from April 2017 to April 2019 were selected,they were divided into the control group (30 cases) and the study group (30 cases) according to the random number table method.The control group was treated with LNG-IUS alone,and the study group was treated with endometrial ablation combined with LNG-IUS.The effect was evaluated 12 months after the operation in both groups.The clinical efficacy,changes in menstrual flow[pictorial blood loss assessment chart (PBAC) scores],degree of dysmenorrhea[visual analogue scale (VAS) scores],endometrial thickness,cancer antigen 125 (CA125) level,and serum sex hormone[follicle-stimulating hormone (FSH),luteinizing hormone (LH),estrogen (E),progesterone (P)]levels,adverse reactions were compared between the two groups.Result:The total effective rate in the study group was 93.33%,which was higher than 73.33% in the control group,the difference was statistically significant (P<0.05).At 12 months after operation,PBAC score,VAS score,endometrial thickness and CA125 level in the study group were (39.26±8.40) points,(1.94±0.62) points,(5.38±0.92) mm,(30.45±5.20) kU/L,respectively,which were lower than (51.98±15.41) points,(2.89±0.75) points,(6.91±1.03) mm,(58.91±7.12) kU/L in the control group,the differences were statistically significant (P<0.05).At 12 months after operation,FSH,LH,E,P levels in the study group were (10.95±1.13) IU/L,(10.15±2.08) IU/L,(0.37±0.06) nmol/L,(0.83±0.11) nmol/L,respectively,which were higher than (8.67±0.92) IU/L,(6.57±1.02) IU/L,(0.28±0.04) nmol/L,(0.62±0.14) nmol/L in the control group,the differences were statistically significant (P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion:Endometrial ablation combined with LNG-IUS can effectively reduce the menstrual volume of patients with adenomyosis,relieve dysmenorrhea,promote endometrial atrophy,and have little impact on serum sex hormone levels,it is safe and feasible,and it is worthy of clinical promotion and application.