左炔诺孕酮宫内缓释系统联合米非司酮治疗子宫腺肌病的临床观察

目的 探讨左炔诺孕酮宫内缓释系统（LNG-IUS）联合米非司酮对子宫明显增大的子宫腺肌病的疗效.方法 对宫腔深度＞9cm的22例子宫腺肌病患者,经米非司酮治疗至宫腔深度≤9cm时放置 LNG-IUS.观察口服米非司酮前、LNG-IUS放置前和放置后3、6、12个月的子宫体积、月经量PBAC评分、痛经 VAS评分,并检测血红蛋白和血清CA125值.结果 （1）米非司酮治疗3～9个月后子宫体积明显缩小,与治疗前比较差异有统计学意义（P＜0.01）;放置LNG-IUS后12个月子宫体积进一步缩小,与放置后3个月比较差异有统计学意义（P＜0.05）.⑵月经量PBAC评分和痛经VAS评分在米非司酮治疗前与放置 LNG-IUS后3、6和12个月比较差异均有统计学意义（P＜0.01）.⑶米非司酮治疗后血红蛋白值升高, 于放置LNG-IUS后6个月复查全部恢复正常,与治疗前比较差异有统计学意义（P＜0.01）;⑷CA125值在米非司酮治疗后下降,与治疗前比较差异有统计学意义（P＜0.01）;放置LNG-IUS后6、12个月持续下降,与放置LNG-IUS前比较差异有统计学意义（P＜0.05）.结论 LNG-IUS联合米非司酮治疗子宫腺肌病可有效缩小子宫体积,减少月经量,缓解痛经症状,改善贫血,并降低血清CA125值.

Evaluation of levonorgestrel-releasing intrauterine system combined with mifepristone in treatment of uterine adenomyosis

Objective To evaluate the efficiency of levonorgestrel-releasing intrauterine system （LNG-IUS） combined with mifepristone in treatment of adenomyosis. Methods Twenty two uterine adenomyosis patients with uterine cavity depth over 9 cm received mifepristone 12.5mg/day for 3 - 9 months. LNG-IUS were inserted when uterine cavity depth were reduced to≤9 cm. The PBAC bleeding scores, visual analogue scale （VAS） scores of pain and the uterine volume were evaluated before and 3, 6, 12 months after treatment; hemoglobin and serum CA125 levels were also measured at each time points. Results The uterine volume decreased 3-9 months after mifepristone treatment （P 〈 0.01） ; and decreased continuously 12 months after inserted LNG-IUS. There were significant difference between mean PBAC scores before and 12 months after treatment （P〈 0.01）. There were significant difference between mean VAS scores changes of dysmenorrheal at baseline and 12 months after treat,emt （P〈 0.01）. Hemoglobin of all cases was significantly increased 6 months after treatment （P 〈 0.01）. Serum CA125 decreased after mifepristone treatment （P 〈0.01 ）; and decreased continuously 6 and 12 months after LNG-IUS was inserted. Conclusion LNG-IUS combined with mifepristone is an effective, safe, and long-term treatment for uterine adenomyosis, it can decrease the uterine volume and the menstrual blood loss, relieve pain and reduce serum CA125 level.