左炔诺孕酮宫内缓释系统治疗围绝经期子宫腺肌症临床疗效分析

目的：探讨左炔诺孕酮宫内缓释系统治疗围绝经期子宫腺肌症的临床疗效。方法选择2011年10月-2013年6月36例放置左炔诺孕酮宫内缓释系统治疗围绝经期子宫腺肌症患者，患者均因月经过多、痛经和/或阴道不规则流血等症状严重影响生活质量。采用月经失血图法（pictorial blood assessment chart，PBAC）、视觉模拟评分法（visualanaloguescale，VAS）及 SF-36健康状况调查问卷，评价患者治疗后1、3、6、12、18个月时月经量变化、痛经症状的缓解程度、月经模式的变化以及生活质量的改善情况。结果放置前月经量评分为（101．09±37．41）分，放置后1、3、6、12、18个月分别为（62．73±20．99）、（40．41±12．28）、（29．23±13．02）、（20．41±12．39）、（17．59±12．20）分，放置后1、3、6、12、18个月较放置前月经量明显减少，差异有统计学意义（P ＜0．05）。放置前视觉模拟评分为（81．45±15．52）分，放置后1、3、6、12、18个月分别为（41．05±17．17）、（25．23±13．67）、（17．91±13．55）、（12．32±12．90）、（10．32±12．19）分，放置后较放置前评分明显降低，差异有统计学意义（P ＜0．05），随着放置时间延长呈递降趋势。放置后1、6、12个月 SF-36评分各维度评分均较放置前有明显提高（P 均＜0．05）。结论左炔诺孕酮宫内缓释系统治疗围绝经期子宫腺肌症是安全有效的，可显著减少子宫腺肌病患者月经量，减轻甚至解除痛经，改善患者的生活质量，降低子宫全切的风险，使患者平稳安全度过围绝经期。

Clinical efficacy of levonorgestrel releasing intrauterine system for the treatment of adenomyosis in perimenopausal women

Objective To evaluate the efficacy of the levonorgestrel-releasing intrauterine system （LNG-IUS）in the treatment of menorrhagia and dysmenorrheal And （or）irregular vaginal bleeding associated with adenomyosis in perimenopausal women.Methods Thirty-six women with dysmenorrhea,menorrhagia,and poor quality of life caused by adenomyosis were involved in the study between October 2011 and June 2013.LNG-IUS was inserted in the postmenstrual phase.Blood loss was assessed by pictorial blood loss assessment chart （PBAC）,and dysmenorrhea intensity was assessed by a visual analogue scale （VAS）.patients were asked to complete a short form 36 （SF-36）health survey questionnaire.which was necessary,followed up after 1 month,3 months,6 months,1 2 months,and after 1 8 months.Results Thirty-four patients were included;Pictorial blood assessment chart （PBAC）was （101.09±37.41）before treatment,after treatment 1 months,3 months,6 months,1 2 months,and after 1 8 months,The PBAC＆amp;nbsp;were （62.73±20.99）,（40.41 ± 12.28）,（29.23 ± 13.02）,（20.41 ± 12.39）,（17.59 ± 12.20）respectively which had significantly differences compared with before treatment （P〈 0.05）.The VAS of dysmenorrhe-al dropped continuously and significantly from the baseline score of （81.45±15.52）to （41.05±17.17）, （25.23±13.67）,（17.91 ± 13.55）,（12.32 ± 12.90）and （10.32 ± 12.19）,respectively,after treatment 1 months,3 months,6 months,12 months,and after 18 months of the LNG-IUS insertion （P 〈 0.05）. Six factors were increased continuously and significantly after the LNG-IUS insertion from 1 month to 1 2 months,respectively （P〈 0.05）.Conclusion There is limited evidence to suggest that LNG-IUS is a safe and effective option for reduces menorrhagia,relieve dysmenorrhea and improve the quality of life in patients with adenomyosis from perimenopausal women.