GnRH-a联合LNG-IUS治疗大子宫腺肌病的临床效果观察  

Effect of levonorgestrel-releasing intrauterine system combined with GnRH analogue for treatment of large adenomyosis

作　　者：郑峥[1] 王宁宁[2] 万俊红[1] 甘小清[1] 郑清泉[2] 柯佩琪[2] 

机构地区：[1]深圳市妇幼保健院妇科,广东深圳518028 [2]中山大学附属第一医院妇科,广东广州510080

出　　处：《南方医科大学学报》2010年第3期541-543,546,共4页Journal of Southern Medical University

基　　金：广东省自然科学基金(8151008901000124;04009377);广东省科技计划项目(2007B080701011;2006B50107001;2005B34201020);广东省医学科研基金(A2009672)

摘　　要：目的观察联合促性腺激素释放激素激动剂(GnRH-a)与放置左炔诺孕酮宫内缓释系统(LNG-IUS)治疗明显增大子宫腺肌病的临床效果。方法12例子宫腺肌病患者,(测宫腔长度≥11cm,平均年龄40.3岁)。接受皮下注射戈舍瑞林3.6mg,每4周1次,至测量宫腔深度≤10cm时,放置LNG-IUS12个月。在用GnRH-a治疗前、放置LNG-IUS后6个月、放置LNG-IUS后12个月进行疼痛VAS评分和月经量PBAC评分,并检测相应子宫体积和血红蛋白变化。结果疼痛VAS评分在GnRH-a治疗前68.3±9.3,放置LNG-IUS后6个月和12个月下降为22.2±8.3和6.8±4.2,之间差异有统计学意义(P<0.05)。月经量PBAC评分在GnRH-a治疗前为153.8±21.6,放置LNG-IUS后6个月和12个月减少为39.2±12.3和16.7±5.2,之间差异有统计学意义(P<0.05)。子宫体积在GnRH-a治疗前为(378.5±39.2)cm3,放置LNG-IUS时为(162.4±49.2)cm3,放置LNG-IUS后6个月和12个月子宫体积分别为(254.3±52.4)和(282.9±56.3)cm3;与GnRH-a治疗前比较,放置LNG-IUS时和放置LNG-IUS后6个月、12个月子宫体积显著缩小(P<0.05);而放置LNG-IUS后6个月较放置LNG-IUS时增大,差异有统计学意义(P<0.05)。血红蛋白于GnRH-a治疗前为(92.6±8.2)g/L,放置LNG-IUS时、放置LNG-IUS后6个月和12个月分别为(113.1±5.2)、(116.5±4.5)、(120.3±4.1)g/L,均较GnRH-a治疗前显著上升,P<0.05。结论联合GnRH-a与LNG-IUS可有效治疗大子宫腺肌病合并疼痛与月经过多。Objective To evaluate the effects of levonorgestrel-releasing intrauterine system （LNG-IUS） combined with GnRH analogue （GnRH-a） in the treatment of adenomyosis with uterine body enlargement. Methods Twelve women （mane age 40.3 years） with adenomyosis and uterine cavity depth over 11 cm received injections of GnRH-a every 4 weeks, and after the uterine cavity depth was reduced to below 10 cm, LNG-IUS was deployed. VAS pain score, PBAC bleeding score, uterine volume, and hemoglobin levels of the women were measured before the treatment and at 6 and 12 months after LNG-IUS placement. Results The VAS pain score was significantly lowered at 6 and 12 month after LNG-IUS placement （P0.05）, and the PBAC bleeding score also showed significant reductions （P0.05）. The uterine volume decreased significantly at 6 and 12 months after LNG-IUS placement as compared with that before the treatment, but was significantly greater at 6 month in comparison with that at the time of LNG-IUS placement （P0.05）. Serum hemoglobin levels underwent significant increments after LNG-IUS placement （P0.05）. Conclusion LNG-IUS combined with GnRH analogue injection can be effective in the treatment of adenomyosis with dysmenorrhea and hypermenorrhea.

关 键 词：促性腺激素释放激素激动剂 左炔诺孕酮宫内缓释系统 子宫腺肌病 痛经 

分 类 号：R711.71[医药卫生—妇产科学]