促性腺激素释放激素激动剂联合左炔诺孕酮宫内缓释系统治疗子宫腺肌病的疗效观察  

Effect of Gn RH-a combined with levonorgestrel-releasing intrauterine system on the treatment of large adenomyosis

作　　者：刘芸[1] 段华[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心,100026

出　　处：《北京医学》2014年第11期905-908,共4页Beijing Medical Journal

摘　　要：目的：探讨促性腺激素释放激素激动剂（GnRH-a）联合左炔诺孕酮宫内缓释系统（LNG-IUS）治疗较大子宫腺肌病的效果。方法入选子宫腺肌病所致中、重度痛经合并月经量过多的患者54例，宫腔深度9~12 cm， GnRH-a治疗3个疗程后放置LNG-IUS，比较治疗前，放置后3个月、6个月、12个月患者的痛经缓解程度、子宫体积变化、血红蛋白及血清CA125水平。结果47例完成研究，患者痛经的VAS评分由治疗前的（75.9±10.3）下降为治疗后的（27.1±8.6），VRS评分由（2.2±0.4）分下降为（1.1±0.2）分，子宫体积由（268.2±12.0）cm3下降为（196.3±7.2）cm3，血清CA125水平由（68.2±22.2）U/ml下降为（43.4±22.1）U/ml，血红蛋白由（87.4±10.3）g/L上升为（123.9±23.1）g/L，差异均有统计学意义（P〈0．01）。且上述指标在弥漫性和局限性子宫腺肌病均有明显改善。结论 GnRH-a联合LNG-IUS治疗宫腔深度在9~12 cm的子宫腺肌病，近期内能有效缓解痛经及月经量过多的临床症状，短期内避免手术治疗可能带来的相关风险，提高生活质量，值得临床应用。但对于局限性子宫腺肌病的患者使用前应与患者充分沟通，密切随访，观察疗效，适时修改治疗方案。Objective To evaluate the effect of gonadotropin releasing hormone agonist （GnRH-a） combined with levonorgestrel-releasing intrauterine system （LNG-IUS） on the treatment of large adenomyosis. Methods Fifty-four women with moderate or severe dysmenorrhea associated with adenomyosis were recruited, whose depth of uterine cavity was from 9 to 12 cm. All women were inserted LNG-IUS following 3 courses of GnRH-a. Three, six and twelve months af-ter the placement of LNG-IUS, the uterine size, degree of dysmenorrhea, hemoglobin and CA 125 values were compared to those before therapy. Results Forty-seven women completed the study. There were significant differences between the mean VAS and VRS scores changes of dysmenorrhea and 12 months follow-up. VAS scores dropped from 75.9 ±10.3 to 27.1±8.6 （P〈0.01）, and VRS scores dropped from 2.2±0.4 to 1.1±0.2 （P〈 0.01）; the uterine volume decreased from （268.2±12.0）cm3 to （196.3±7.2）cm3 （P〈 0.01）; the serum CA125 values dropped from （68.2±22.2）U/ml to （43.4±22.1）U/ml （P〈 0.01）; the hemoglobin level increased from （87.4±10.3）g/L to （123.9±23.1）g/L. All these changes happened in both diffuse and focal adenomyosis patients. Conclusion GnRH-a combined with LNG-IUS is effective in the treatment of large adenomyosis with moderate or severe dysmenorrhea.

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]