不同剂量米非司酮联合曼月乐在子宫腺肌病病灶切除术后的应用效果观察

Clinical observation of different doses of mifepristone combined with Mirena after adenomyosis lesion resection

目的探讨子宫腺肌病病灶切除术后应用不同剂量米非司酮口服联合曼月乐环宫内放置治疗的临床效果。方法选取2019年9月至2022年9月安徽省宣城市中心医院妇科收治的80例子宫腺肌病病灶切除术患者为研究对象,随机将其分为对照组和观察组各40例。对照组术后予以正常剂量米非司酮(10 mg/d)口服联合曼月乐环宫内放置治疗,观察组术后予以低剂量米非司酮(5 mg/d)口服联合曼月乐环宫内放置治疗。比较两组月经量、子宫体积、痛经程度、肿瘤标志物、血红蛋白、卵巢功能指标及不良反应发生率。结果与治疗前比较,两组视觉模拟评分法(VAS)评分、子宫体积、月经量、雌二醇(E_(2))、促黄体生成素(LH)、卵泡刺激素(FSH)、血清糖类抗原125(CA125)水平均有降低,血红蛋白(Hb)水平升高(P<0.05);治疗3个月后,两组VAS评分、子宫体积、月经量、E_(2)、LH、FSH、CA125及Hb水平比较,差异无统计学意义(P>0.05)。观察组不良反应发生率(5.00%)低于对照组(20.00%)(P<0.05)。结论在子宫腺肌病病灶切除术后应用曼月乐环宫内放置联合正常剂量及低剂量米非司酮口服治疗,均可有效改善患者卵巢功能、痛经及贫血症状,促使子宫体积及月经量恢复正常,但联合低剂量米非司酮口服治疗安全性较高。

Objective To explore the clinical effect of different doses of mifepristone orally combined with intrauterine placement of Mirena after adenomyosis lesion resection.Methods 80 patients with adenomyosis treated in the Department of Obstetrics and Gynecology of Xuancheng City Central Hospital of Anhui Province from September 2019 to September 2022 were selected as the study subjects.They were randomly divided into control group and observation group with 40 cases in each group.The control group was treated with normal dose of mifepristone orally(10 mg/d)combined with intrauterine placement of Mirena after operation,while the observation group was treated with low dose of mifepristone orally(5 mg/d)combined with intrauterine placement of Mirena after operation.The menstrual volume,uterine volume,degree of dysmenorrhea,tumor marker index,hemoglobin(Hb),ovarian function and incidence of adverse reactions were compared between the two groups.Results Compared with before treatment,both groups showed a decrease in visual analogue scale(VAS)scores,uterine volume and menstrual volume,levels of estradiol(E_(2)),luteinizing hormone(LH),follicle stimulating hormone(FSH),serum carbohydrate antigen 125(CA125),and increased levels of hemoglobin(Hb)(P<0.05).After 3 months of treatment,there were no statistically significant difference in VAS scores,uterine volume,menstrual volume,E_(2),LH,FSH,CA125,and Hb levels between the two groups(P>0.05).The incidence of adverse reactions in the observation group(5.00%)was lower than that in the control group(20.00%)(P<0.05).Conclusion After the resection of adenomyosis,the application of intrauterine placement of Mirena combined with normal dose and low dose mifepristone oral treatment can effectively improve the ovarian function,dysmenorrhea and anemia symptoms of patients,and promote the uterine volume and menstrual volume to return to normal,but the combination of low dose mifepristone oral treatment is relatively safe.