LNG-IUS联合TCRE治疗子宫腺肌病的疗效分析  

Curative Effect of Levonorgestrel-releasing Intrauterine System( LNG-IUS) Combined Transcervical Resection of Endometrium( TCRE) for Treatment of Adenomyosis

作　　者：周宇涵[1] 樊伍峰[1] 

机构地区：[1]湖北医药学院附属襄阳医院,湖北襄阳441000

出　　处：《湖北医药学院学报》2015年第5期457-460,464,共5页Journal of Hubei University of Medicine

摘　　要：目的:研究左炔诺孕酮宫内缓释系统(Levonorgestrel-releasing intrauterine system,LNG-IUS)联合子宫腺肌症内膜电切术(Transcervical resection of endometrium,TCRE)治疗子宫腺肌病的治疗效果。方法:选取同时期就诊的子宫腺肌病患者118例,按照不同治疗方式随机分为TCRE组、LNG-IUS组、联合治疗组三组,对其一般资料、雌激素受体(ER)、孕激素受体(PR)、血管内皮生长因子(VEGF)、微血管密度(MVD)、CA-125以及临床指标:子宫内膜厚度、子宫体积、月经量、痛经情况进行回顾性分析和疗效比较。结果:⑴三组患者VEGF、MVD、CA-125、子宫内膜厚度、月经量(PBAC评分)、痛经(VAS评分)均较治疗前显著下降(P<0.05),而子宫体积TCRE组和LNG-IUS组治疗前后无显著差异(P>0.05),联合治疗组子宫体积治疗前后有显著性差异(P<0.05);TCRE组治疗前后ER和PR无显著性差异(P>0.05),LNG-IUS组和联合治疗组治疗前后ER和PR显著下降(P<0.05)。三组患者治疗后组间比较存在显著性差异(P<0.05),联合治疗组子宫内膜厚度、子宫体积、月经量、痛经、CA-125和VEGF、MVD、ER、PR均显著下降(P<0.05);⑵通过线性相关分析,ER与VEGF、MVD具有正相关性(r=0.641,r=0.597),VEGF和MVD具有正相关性(r=0.623),PR与ER、VEGF、MVD相关性不显著(r=-0.234,r=0.049,r=0.073)。结论:三种治疗方式均有一定疗效,其中TCRE联合LNG-IUS治疗子宫腺肌病的临床疗效最好,对VEGF、MVD和ER具有更显著的降调作用,能持续抑制子宫内膜的修复增生,延缓单一TCRE和LNG-IUS治疗后的疾病复发,改善患者生活质量。Objective To study the curative effects of LNG-IUS combined TCRE for treatment of patients with adenomyosis. Methods Total 118 patients with adenomyosis that hospitalized simultaneously were enrolled, and then divided into TCRE group,LNG-IUS group and combined group randomly. The general data, estrogen receptor （ ER）, progesterone receptor （ PR）, vascular endothelial growth factor （.VEGF）, microvascular density （ MVD）, CA- 125 and clinical indicators including endometrial thickness,uterine volume, menstrual quantity and dysmenorrhea status were retrospectively analyzed and compared among three groups. Results The VEGF, MVD, CA-125, endometrial thickness, PBAC score of menstrual quantity and VAS score of dysmenorrhea of three groups were significantly decreased after treatment （ P 〈 0.05 ）. There were no significant difference on the uterine volume before and after treatment in both TCRE and LNG-IUS group（ P 〉 0.05 ）, but it had significantly different in combined group （ P 〈 0.05）. ER and PR had no significant difference in TCRE group （ P 〉 0.05）, while they had a significant decrease in both LNG-IUS and combined group before and after treatment（ P 〈 0.05 ）. All the indexes were significantly different among three groups after treatment, meanwhile the endometrial thickness, uterine volume, menstrual quantity, dysmenorrhea, CA-125, VEGF, MVD, ER and PR were significantly decreased in combined group （ P 〈 0.05 ）. Through the linear correlation analysis, ER was positively correlated with VEGF and MVD （ r = 0. 641, r = 0. 597 ）, VEGF was positively correlated with MVD （r = 0.623 ）, PR had no significant correlation with ER, VEGF and MVD （ r = - 0. 234, r = 0. 234, r = 0. 073）. Conclusion All three treatment methods have a certain curative effects, and LNG-IUS combined TCRE treatment has the best clinical curative effect in patients with adenomyosis. The combined treatment could inhibit the recovery and hyperplasia of endometrium, delay the relapse of ade

关 键 词：子宫腺肌病 宫腔镜下子宫内膜电切术 左炔诺孕酮宫内缓释系统 雌激素受体 孕激素受体 血管内皮生长因子类 微血管密度 

分 类 号：R711.74[医药卫生—妇产科学]