左炔诺孕酮宫内缓释系统的临床应用分析

Clinical analysis of levonorgestrel intrauterine system

目的:探讨放置左炔诺孕酮宫内缓释系统(LNG-IUS)的临床适应证、效果及副作用,为临床有效安全应用提供依据。方法:回顾性分析本中心近5年放置左炔诺孕酮宫内缓释系统共371例临床资料。结果:LNG-IUS的临床适应证主要有子宫腺肌症或子宫内膜异位症(49.3%)、月经过多或月经紊乱(17.5%)、子宫内膜病变(14.0%)、子宫内膜息肉术后(8.9%)、避孕(7.3%)等。放置LNG-IUS后痛经程度较术前减轻[VAS评分(3.2±1.3)分比(5.6±1.4)分;t=15.588,P<0.001]。月经过多治疗有效率达74.2%。LNG-IUS治疗子宫内膜病变的内膜病理转化率100%。子宫内膜息肉术后放置LNG-IUS 6个月子宫内膜厚度与术前差异有统计学意义[(0.5±0.1)cm比(0.8±0.3)cm;t=4.505,P<0.001)]。LNG-IUS的1、2、3年续用率分别为86.1%(261/303)、84.2%(170/202)、80.9%(89/110)。LNG-IUS放置后副作用主要有闭经(40.7%)、不规则阴道出血(39.6%)、腰部酸胀(9.4%)。结论:放置LNG-IUS在减轻痛经、减少月经量、治疗子宫内膜病变、预防子宫内膜息肉复发等方面有良好效果,长期持续使用率高。放置LNG-IUS术前应对患者进行充分咨询,知情选择提高依从性。

Objective:To explore the clinical indications,effect and side effects of levonorgestrel intrauterine system(LNG-IUS),and to provide the references for the effective and safe clinical application of LNG-IUS.Methods:A retrospective analysis on 371cases treated with LNG-IUS during the last 5years was conducted.Results:The main indications of the women with LNG-IUS inserted in clinic included adenomyosis/endometriosis(49.3%),menorrhagia(17.5%),endometrial lesions(14.0%),after transcervical resection of endometrial polyp(8.9%)and contraception(7.3%),etc.The dysmenorrhea of the women after LNG-IUS treatment relieved significantly,and the VAS score(3.2±1.3points)of the women after LNG-IUS treatment was significantly lower than that(5.6±1.4points)before treatment(t=15.588,P<0.001).The effective rate of LNG-IUS for treating the menorrhagia of the women was 74.2%.The pathological effective rate of LNG-IUS for treating the endometrial lesions was 100%.There was significant difference in the endometrial thickness(0.5±0.1cm vs.0.8±0.3cm)of the women between the LNG-IUS treatment for 6 months and before treatment(t=4.505,P<0.001).The continuation rate of LNG-IUS used of the women in 1-year,2-years,and 3-years after surgery were 86.1%(261/303),84.2%(170/202),and 80.9%(89/110),respectively.The main side effects of the women after LNG-IUS inserted were amenorrhea 40.7%,irregular vaginal bleeding 39.6%,and lumbar soreness 9.4%.Conclusion:LNG-IUS inserted of the women achieves good effect for treating their dysmenorrhea,menorrhagia and endometrial lesions,and for preventing their recurrence of endometrial polyp after transcervical resection.LNG-IUS has high continue use rate for a long time.The sufficient consultation and the informed choice of the women before LNG-IUS inserted should be done to improve their compliance.