左炔诺孕酮宫内缓释系统治疗子宫肌瘤伴月经过多的临床观察  

Clinical effects of delayed levonorgestrel-releasing intrauterine system on leiomyoma accompanied by menorrhagia

作　　者：王联欢[1] 

机构地区：[1]浙江中医药大学附属广兴医院妇产科,杭州310007

出　　处：《解放军医学杂志》2009年第5期625-626,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的观察左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫肌瘤伴月经过多的临床效果。方法选择32例确诊为子宫肌瘤伴月经过多、中度以上贫血的患者,在月经周期第5～7天放置曼月乐宫内节育器,分别于放置前及放置后3、12个月观察月经量并按PBAC法进行评分,同时测定血红蛋白浓度、子宫体积、肌瘤大小及血清雌二醇(E2)、促黄体素(LH)、促卵泡激素(FSH)、血脂四项(胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)水平。随诊记录阴道出血等不良反应的发生情况。结果放置曼月乐3个月后月经量评分由放置前的201.5±78.1下降至52.2±13.7,12个月后降至20.3±6.3(P<0.01);血红蛋白放置前为78±14g/L,3个月后上升至107±13g/L,12个月后上升至125±9g/L(P<0.01);子宫体积放置前为580±78.2cm3,3个月后缩小至514±79.2cm3,12个月后缩小至412±56.3cm3(P<0.01);肌瘤直径放置前为3.8±1.1cm,3个月后缩小至3.0±0.8cm,12个月后缩小至2.0±0.7cm(P<0.05),而血清E2、LH、FSH、血脂四项与放置前比较均无明显变化(P>0.05)。放置曼月乐后12个月的月经量、血红蛋白水平、子宫体积、肌瘤直径与放置后3个月比较差异显著(P<0.05)。随诊3个月时,15例患者存在不规则点滴出血,10例出血规律但经期延长。随诊1年仅2例不规则出血。结论宫腔放置曼月乐宫内节育器能有效减少患者月经量,纠正贫血,使子宫肌瘤缩小,而对卵巢功能及血脂代谢无明显影响。Objective To observe the clinical effect of delayed levonorgestrel-releasing intrauterine system （Manyuele） on leiomyoma accompanied by menorrhagia. Methods Thirty-two patients with uterine leiomyoma accompanied by menorrhagia and moderate or severe anemia were involved in present study. The Manyuele intrauterine contraceptive device was applied at the 5th to 7th day of menstrual cycle, the menstrual blood volume was observed and assessed by PABC scale, and hemoglobin concentration, uterus volume, tumor size, levels of estradiol （E2）, lutropin （LH）, follicle stimulating hormone （FSH） in serum, and four items of blood lipid index （cholesterol, triglyceride, high and low density lipoprotein） were determined before and 3 and 12 months after Manyuele applied. The adverse reactions such as vaginal bleeding were recorded. Result The scores of menstrual blood volume was 201. 5±78. 1 before Manyuele application, and declined to 52. 2±13. 7 and 20. 3±6. 3, respectively, on the 3rd and 12th months after Manyuele application （P〈0. 01）; the hemoglobin concentra tion was 78±14g/L before Manyuele application, and increased to 107±13g/L and 125±9g/L, respectively, on the 3rd and 12th months after Manyuele application （P〈0. 01）; the uterus volume was 580±78. 2cm^3 before Manyuele application, and decreased to 514±79.2 cm^3 and 412±56.3 cm^3, respectively, on the 3rd and 12th month after Manyuele application （P〈0. 01）; the tumor diameter was 3. 8±1.1cm before Manyuele application, and decreased to 3.0±0. 8cm and 2.0±0. 7cm, respectively, on the 3rd and 12th month after Manyuele application （P〈0. 05） ; while no significant changes were found on serum E2, LH, FSH and four items of blood lipid index during this periond （P〉0. 05）. After being followed-up for 3months, irregular dropwise bleeding was found in 15 eases, and 10 cases had regular bleeding with prolonged menstruation. Only 2 cases had irregular dropwise bleeding one year later. Condusion Manyuele intrauterine co

关 键 词：左炔诺孕酮 宫内避孕器 含药 平滑肌瘤 月经过多 

分 类 号：R737.33[医药卫生—肿瘤]