GnRH-a联合LNG-IUS治疗38例大子宫腺肌病的临床观察  

Clinical study of the treatment of levonorgestrel-releasing intrauterine system combined with GnRH analogue in 38 cases with large adenomyosis

作　　者：孙广范[1] 陶艳玲[2] 尚雪[1] 林霞[1] 栾峰[1] 

机构地区：[1]南方医科大学附属中山博爱医院,广东中山528403 [2]吉林省妇幼保健院

出　　处：《中国妇幼保健》2012年第32期5177-5181,共5页Maternal and Child Health Care of China

摘　　要：目的:探讨联合应用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)治疗大子宫腺肌病的临床效果。方法:38例大子宫腺肌病患者(测宫腔长度≥10 cm)接受皮下注射达菲林3.75 mg,每4周1次,至测量宫腔深度≤9 cm时由专人放置LNG-IUS。在用GnRH-a治疗前、放置LNG-IUS后6、12、18、24个月进行痛经VAS评分和月经量PBAC评分,并检测子宫体积和血红蛋白变化情况。结果:放置LNG-IUS后6、12、18、24个月痛经评分、月经量评分与GnRH-a治疗前比较明显降低,差异有统计学意义(P<0.05);并且放置LNG-IUS后12、18、24个月痛经评分、月经量评分与放置后6个月比较差异也有统计学意义(P<0.05),而放置LNG-IUS后12、18、24个月痛经评分、月经量评分比较差异无统计学意义(P>0.05)。子宫体积在放置LNG-IUS时与GnRH-a治疗前比较显著变小(P<0.05)。放置LNG-IUS后6和12个月较放置LNG-IUS时增大(P<0.05),但仍较GnRH-a注射治疗前小(P<0.05);且放置LNG-IUS后18、24个月子宫体积逐渐缩小,与GnRH-a注射治疗前及放置LNG-IUS后6、12月比较差异有统计学意义(P<0.05),而与放置LNG-IUS时比较差异无统计学意义(P>0.05)。血红蛋白在GnRH-a联合LNG-IUS治疗后升高至正常,与GnRH-a治疗前相比差异有统计学意义(P<0.05),而放置LNG-IUS后6、12、18、24个月之间血红蛋白比较差异无统计学意义(P>0.05)。结论:注射GnRH-a后联合放置LNG-IUS对大子宫腺肌病合并的痛经与月经过多有显著的治疗效果。Objective ： To study 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： A total of 38 cases （ measured uterine length ≥ 10 cm, average age 36. 7 years） with adenomyosis received injections of GnRH - a （ Da Feilin） every 4 weeks, and after the uterine cav- ity depth was reduced to below 9 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, 12, 18 and 24 months after LNG- IUS placement. Results： The VAS pain score and PBAC bleeding score were significantly lowered at 6, 12, 18 and 24 months after LNG - IUS placement （P 〈0. 05）, and the score at 12, 18 and 24 month were significantly lower than that at 6 month. The uterine volume decreased significantly at the time of LNG -IUS placement, 6 and 12 month after LNG- IUS placement as compared with that before the treatment of GnRH - a, but was significantly greater at 6 and 12 month than that at the time of LNG - IUS placement （P 〈 O. 05） . And the uterine volume decreased signifi- cantly at 18 and 24 month in comparison with that at 6 and 12 month after LNG - IUS placement and before the treatment of GnRH - a, but was not statistically significant in comparison with that at the time of LNG - IUS placement. Serum hemoglobin levels was increased gradually to normal after combined treatment （P 〈 0. 05） . The difference of the VAS pain score, PBAC bleeding score serum and the hemoglobin levels were not significant from each other （6, 12, 18, 24 months after LNG -IUS placement, P 〉0. 05） . Conclusion： The therapeutic alliance of LNG - IUS placement after GnRH analogue injection can be effective for the large adenomyosis with dysmenorrhea and hypermenorrbea.

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：R711.5[医药卫生—妇产科学]