促性腺激素释放激素激动剂联合左炔诺孕酮宫内节育系统在子宫腺肌瘤病损切除术后的临床研究

Clinical study of gonadotropin releasing hormone agonist combined with levonorgestrel intrauterine contraceptive system in patients with uterine adenomyoma after lesion resection surgery

目的探讨促性腺激素释放激素激动剂(GnRH-a)联合左炔诺孕酮宫内节育系统在子宫腺肌瘤病损切除术后的应用效果。方法选取2019年9月至2021年8月于抚州市市立医院行经腹、腹腔镜病损切除术的60例子宫腺肌瘤患者作为研究对象,按计算机分组法分为研究组与对照组,每组30例。对照组术后采用左炔诺孕酮宫内节育系统治疗,研究组术后采用GnRH-a联合左炔诺孕酮宫内节育系统治疗,比较两组治疗前后月经量、月经周期和糖类抗原125(CA125)、性激素[促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)]水平、视觉模拟评分法(VAS)评分及不良反应发生率。结果治疗28d后,两组月经量评分、CA125水平均低于治疗前,月经周期短于治疗前,且研究组月经量评分、CA125水平均低于对照组,月经周期短于对照组,差异有统计学意义(P<0.05)。治疗后,两组FSH、LH、E2水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗14、28d后,两组VAS评分均低于前一时间点,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组不良反应发生率为3.33%,低于对照组的26.67%,差异有统计学意义(P<0.05)。结论子宫腺肌瘤病损切除术后采用GnRH-a联合左炔诺孕酮宫内节育系统治疗效果确切,可减少患者月经量,缩短月经周期,降低CA125及性激素水平,显著改善其痛经情况,且不良反应发生风险较低,安全性均高,值得临床进一步推广应用。

Objective To explore the application effect of gonadotropin releasing hormone agonist(GnRH-a)combined with levonorgestrel intra-uterine contraceptive system uterine adenomyoma after lesion resection surgery.Methods 60 patients with uterine adenomyoma who underwent transabdominal and laparoscopic lesion resection in Fuzhou Municipal Hospital from September 2019 to August 2021 were selected as the study sub-jects,and they were divided into the study group and the control group according to computer grouping method,with 30 cases in each group.The control group treated with levonorgestrel intrauterine contraceptive system after surgery,while the study group treated with GnRH-a combined with levonorgestrel intrauterine contraceptive system after surgery,the menstrual volume,menstrual cycle,carbohydrate antigen 125(CA125),levels of sex hormones(follicle stimulating hormone[FSH]),(luteinizing hormone[LH],estradiol[E2]),visual analogue scale(VAS)scores before and after treatment,and incidence of adverse reactions were compared between the two groups.Results After 28 d of treatment,the menstrual volume score,CA125 level of the two groups was lower than before treatment,the menstrual cycle was shorter than before treatment,and the menstrual volume score,CA125 level in the study group was lower than those in the control group,menstrual cycle was shorter than that in the control group,the differ-ences were statistically significant(P<0.05).After treatment,the levels of FSH,LH,and E2 of the two groups were lower than before treatment,and the study group was lower than the control group,the differences were statistically significant(P<0.05).After 14 and 28 d of treatment,the VAS scores of the two groups were lower than the previous time point,and the study group were lower than the control group,and the differences were sta-tistically significant(P<0.05).The incidence of adverse reactions in the study group was 3.33%,which was lower than 26.67%in the control group,and the difference was statistically significant(P<0.05).Conclusion GnRH-a combined with levonorgestrel intrauterine contraceptive system in patients with uterine adenomyoma after lesion resection surgery has definite therapeutic effect,can reduce menstrual volume,shorten menstrual cy-cle,reduce CA125 and sex hormone levels,significantly improve dysmenorrhea,and have low risk of adverse reactions and high safety,which is worthy of further clinical promotion and application.