左炔诺孕酮宫内缓释系统与孕三烯酮治疗子宫腺肌病的临床疗效  

Clinical Study of Levonorgestrel-releasing Intrauterine System(LNG-IUS)and Gestrinone in Treating Adenomyosis

作　　者：杨冰[1] 叶元[1] 陈辉[2] 何丽霞[1] 王晓谦[1] 唐柳林[1] 

机构地区：[1]广西桂林医学院附属医院妇科,桂林541001 [2]广西桂林医学院附属医院超声影像科,桂林541001

出　　处：《生殖与避孕》2014年第5期426-431,共6页Reproduction and Contraception

基　　金：广西桂林市科学研究与技术开发计划项目;项目编号:20110119-1-5

摘　　要：目的:研究比较左炔诺孕酮宫内缓释系统(LNG-IUS)和孕三烯酮2种方法治疗子宫腺肌病的临床疗效及不良反应。方法:选择60例子宫腺肌病患者为研究对象,随机分为观察组和对照组,观察组(n=30)行宫腔内放置LNG-IUS治疗,对照组(n=30)给予口服孕三烯酮治疗。观察治疗前、治疗后1个月、3个月、6个月、12个月、24个月的痛经程度、月经量、子宫内膜厚度和体积及相关不良反应;痛经程度用视觉模拟评分(VAS)评估。结果:观察组和对照组治疗痛经、月经过多以及子宫内膜增厚的疗效均良好,与治疗前比较有统计学差异(P<0.05);观察组与对照组比较VAS评分、月经量、子宫内膜厚度均明显减少,观察者和对照组间比较(除了治疗6个月)差异有统计学意义(P<0.05);对照组患者停药后上述指标均有回升,而观察组均稳定维持低值;治疗后患者的子宫体积仅略有缩小,但与治疗前比较差异均无统计学意义(P>0.05)。对照组不良反应有体质量增加、痤疮、潮热及肝、肾功能损伤等,而观察组的主要不良反应主要为放置后不规则阴道流血和闭经,阴道流血一般3个月后可以自行停止。观察组其余的不良反应较对照组相对略少,无统计学差异。结论:LNGIUS较孕三烯酮能更有效地治疗子宫腺肌病患者的症状,且不良反应少,具有长效、创伤小、可逆性和平均费用低的优势,且有避孕效果,可考虑作为首选的保守治疗方法。Objective： To study and compare the clinical effect and adverse reaction of levonorgestrel- releasing intrauterine system （LNG-IUS） and gestrinone in treating adenomyosis. Methods： Sixty patients diagnosed with adenomyosis were selected as the subjects, and were rondomized into the observation group （n=30） and control group （n=30）. Patients in observation group were treated by placing LNG-IUS, while patients in the control were treated by oral gestrinone. Degree of dysmenorrhea, menstrual blood volume, endometrial thickness and volume, and adverse reaction of the patients were observed 1 month, 3 months, 6 months, 12 months and 24 months before and after the treatment. Degree of dysmenorrhea was evaluated by visual analogue system （VAS） scores. Results： The observation and control groups had gained better curative effect in treating dysmenorrhea, menorrhagia and the endometrial thickening, which was of statistical difference compared with those before the treatment （P〈0.05）; compared with the control, the VAS score, menstrual blood volume and the endometrial thickening were obvious reduced, there were statistical differences between the two groups （except for the 6-month treatment） （P〈0.05）. The above-mentioned indicators in the control rised again, while remained stable and low levels in observation group. After the treatment, the uterine volume of the patients in both groups contracted to a certain degree, but there was no statistical difference between the two groups compared with that before the treatment （P〉0.05）. Such adverse reactions as weight gaining, occurrence of ache and the affecting of hepatic and renal functions had been observed in the control treated by gestrinone, while in observation group, the main adverse reaction occurred in patients was the irregular vaginal bleeding and amenorrhea, and vaginal bleeding could stop spontaneously after 3 months. Compared with the control, the observation group brought less adverse reaction. Conclusion： LNG-IUS has

关 键 词：左炔诺孕酮宫内缓释系统(LNG—IUS) 孕三烯酮 子宫腺肌病 疗效 不良反应 

分 类 号：R711.71[医药卫生—妇产科学]