左炔诺孕酮宫内缓释系统治疗子宫腺肌症的临床观察

目的探讨左炔诺孕酮宫内缓释系统（LNG-IUS）治疗子宫腺肌症（AM）疼痛的效果、并发症以及影响疗效、续用率的因素。方法回顾性分析2004年1月至2008年10月在本院放置LNG-IUS治疗中、重度痛经的AM患者83例。分为促性腺激素释放激素激动剂（GnRH—a）组和直接放置组，分别在放置后3个月、6个月、1年、2年、3～5年随访，观察CA125值，子宫体积，疼痛及月经情况、续用率等。结果在6个月、1、2及3～5年随访中直接放置组和GnRH—a组CA125、子宫大小、疼痛评分均较放置前组明显下降（P〈0．05），但是直接放置组在3个月时子宫体积变化较放置前无明显差异，CA125值、疼痛缓解情况较放置前组有统计学意义，GnRH—a组在3个月时痛经缓解有效率明显高于直接放置组（35／39）vs（24／35），（P=0．04）。放置LNC-IUS后经期延长和不规则出血，3个月时分别为50％和22．97％，6个月时为37．04％和11．1％，1年时为25．9％和11．1％。随着放置时间的延长，患者不规则出血和经期延长情况有所好转。分别在3个月、6个月、1年时比较两组不规则出血和经期延长情况，无统计学差异。两组总的续用率6个月为88．6％；1年为74％。单因素分析发现仅LNG-IUS在官腔内的位置情况与续用率明显相关。结论LNG-IUS在缓解AM痛经症状的长期疗效是显著的。术前应用GnRH—a不能减少不规则出血时间，但可作为诱导用药在LNC-IUS完全起效前联合使用，提高疗效。续用率与置器后位置显著相关。

The clinical observation of levonorgestrel intrauterine system in treatment of adenomyosis

Objective： To evaluate the efficacy and side effects of the levonorgestrel releasing intrauterine system （LNG-IUS） in treatment of adenomyosis,as well as the influencing factors of treatment and continuation rate. Methods： From January 2004 to October 2008 in Peking Union Medical College Hospital, 83 women who had moderate or severe dysmenorrhea associated with adenomyosis diagnosed by pathology or MRI or transvaginal sonography were treated by LNG-IUS. The patients with LNG-IUS placed were divided into GnRH-a group and direct placement group. During 3 months, 6 months, 1 year, 2 years, 3-5-years＇ fol- low-up, uterine size, CA125, pain score, menstrual conditions and continuation rate were retrospective analysised. Results： During 6 months, 1 year, 2 years, 3-5-years＇ follow-up, the VAS of dysmenorrhea, the uterine volume, the serum CA125 levels decreased continuously and significantly from the baseline score in both groups （P〈0. 05）. However, After 3 months of treatment, dysmenorrhea was alleviated significantly in GnRH-a group than the direct placementgroup（35/39） vs （24/35）, P=0.04]. Menostaxisorirregular bleeding was common after LNG IUS placing, the incident rates was 50% and 22.97% in 3 months, 37.04% and 11.1% in 6 months, 25.9% and 11.1% after 1 year respectively. In 3 months, 6 months, 1 year comparation of irregular menstrual bleeding and menostaxis between two groups, no statistical difference was found. The overall continuation rate of two groups after 6 months was 88.6 % ; 1 year was 74%. Single-factor analysis showed that only the site of LNG-IUS in uterus was significantly associated with continuation rate. Conclusions： The insertion of a LNG-IUS led to a releasing of pain with adenomyosis. Preoperative application of GnRH-a could not reduce irregular bleeding, but could be used as pre-treatment before LNG-IUS reached its maximum effect, enhanced the effectiveness of treatment. The continuation rate and the location of LNG-IUS were significant correlated.