左炔诺孕酮宫内缓释系统治疗子宫腺肌病不良反应的干预性处理  

Interventional treatment for adverse reactions caused by levonorgestrel releasing intrauterine system( LNG-IUS) in treating uterine adenomyosis

作　　者：杨冰[1] 丁珊珊[1] 叶元[1] 李昱川[1] 尹茳平[1] 陈辉[2] 

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

出　　处：《医学研究生学报》2015年第4期402-405,共4页Journal of Medical Postgraduates

基　　金：桂林市科学研究与技术开发计划项目(20110119-1-5)

摘　　要：目的随着左炔诺孕酮宫内缓释系统(levonorgestrel releasing intrauterine system,LNG-IUS)适应证的不断扩展,由其引起的一系列不良反应也逐渐受到重视。文中通过提供参考观察LNG-IUS治疗子宫腺肌病中的重要不良反应,对干预性处理的可行性进行探讨,为其减少LNG-IUS不良反应、增加其使用率和使用年限、提高治疗效果。方法回顾性分析2012年1月至2013年12月期间在桂林医学院附属医院诊断为子宫腺肌病并自愿接受LNG-IUS治疗的67例患者作为研究对象,根据不同处理方法纳入干预组(n=34)和对照组(n=33)。干预组放置LNG-IUS后立即予干预性处理,即口服非甾体抗炎药吲哚美辛25 mg,1片/次、3次/d,连服7 d,同时口服去氧孕烯炔雌醇1次/d、1片/次,连服21 d,连用3个周期;对照组仅予病情沟通未做特殊处理。分别观察和记录治疗后1、3、6个月相关不良反应。结果经干预性处理后,干预组1、3、6个月的子宫异常出血发生率分别为8例(23.5%)、4例(11.7%)、0例(0%);而对照组发生率分别为20例(60.6%)、12例(36.4%)、4例(12.1%)。组间各月比较差异均有统计学意义(P<0.05)。观察至6个月,闭经的总发生率为干预组8例(23.5%),对照组2例(6.1%),组间比较差异有统计学意义(P<0.05);卵巢囊肿总发生率为干预组1例(2.9%),对照组7例(21.2%),差异有统计学意义(P<0.05);环脱落或环移位总发生率干预组1例(2.9%),对照组6例(18.2%),差异有统计学意义(P<0.05)。结论子宫腺肌症患者放置LNG-IUS后立即予口服非甾体抗炎药和短效避孕药的干预性处理可明显降低放置后子宫异常出血和其他不良反应的发生率,临床应用具有较好的可行性。Objective The adverse reactions of levonorgestrel releasing intrauterine system （ LNG-IUS） has been emphasized with the increase of its indications.The study was to investigate the feasibility of interventional treatment in treating uterine adenomyosis with LNG-IUS by observing its adverse reactions, trying to reduce its adverse reaction, increase its utilization ratio and service life and improve its efficacy. Methods Retrospective analysis was made on 67 patients with uterine adenomyosis who were willing to accept LNG-IUS treatment from January 2012 to December 2013 in our hospital.The patients were randomly divided into observation group （ n=34） and control group（ n=34） according to different therapies.The observation group were given interventional treatment immedi-ately after the placement of LNG-IUS, that is to take oral non-steroidal anti-inflammatory drug （ indomethacin, 25 mg, 1 pill each time, three times a day） for 7 consecutive days and desogestrel-ethinylestradiol （ marvelon, 1 pill a day） for 21 consecutive 21 days, 3 con-secutive cycles;while the control group were only given communications without any special treatment.Observation and record were made on related adverse reactions at 1 month, 3 months and 6 months after the treatment. Results At 1 month, 3 months and 6 months after the interventional treatment, the incidence rates of abnormal uterine bleeding between two groups were of significant difference （ 23.5%vs 60.6%, 11.7%vs 36.4%, 0%vs 12.1%, P30.05） in the control group. At 6 month after the treatment, statistical difference was found in the total incidence rates of amenorrhea, ovarian cysts, dislocation and out of place of IUD between these two groups （ 23.5%vs 6.1%, 2.9%vs 21.2%, 2.9%vs 18.2%, P30.05）. Conclusion The research has indicated that the adoption of interventional treatment after placing LNG-IUS can obviously reduce the occurrence of the main adverse reactions, so it is feasible in clinical application.

关 键 词：左炔诺孕酮宫内缓释系统 子宫腺肌病 不良反应 干预性处理 

分 类 号：R711[医药卫生—妇产科学]