左炔诺孕酮宫内缓释系统用于治疗顽固性功能失调性子宫出血的临床疗效观察

目的探讨左炔诺孕酮宫内缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)治疗顽固性功能失调性子宫出血(简称功血)的疗效及不良反应。方法 42例内膜病理检查示子宫内膜简单型增生过长的顽固性功血患者,于月经第5～7天或诊刮后5～7天放置左炔诺孕酮宫内缓释系统。放环前、放环后3、6、12、24个月均行月经量PBAC评分、血红蛋白水平检测、B超测量子宫内膜厚度、子宫内膜病理检查。结果放置左炔诺孕酮宫内缓释系统后患者月经量减少,PBAC评分从治疗前的131.4±48.1,降至治疗后12个月的28.2±7.1g/L(P<0.001)。血红蛋白值治疗前为78.76±11.80g/L,治疗后12个月升高至124.20±7.28(P<0.001)。B超测定子宫内膜厚度治疗前为15.68±4.11mm,治疗12个月后减少至4.98±0.68mm(P<0.001),并持续菲薄。治疗12个月后子宫内膜病理检查显示子宫内膜转化为分泌期改变及间质蜕膜样改变,内膜转化率为100%。结论 LNG-IUS治疗顽固性功血可明显减少月经量、纠正贫血;可有效抑制子宫内膜增生、促进子宫内膜转化。它具有安全、有效、无手术创伤,不良反应少的优点。

Evaluation of Levonorgestrel-releasing Intrauterine System in Treatment of Obstinate Dysfunctional Uterine Bleeding

Objective To evaluate the efficiency and side-effects of the levonorgestrel-releasing intrauterine system(LNG-IUS)in the treatment of obstinate dysfunctional uterine bleeding.Methods Forty two cases of dysfunctional uterine bleeding with endometrial hyperplasia by pathologic diagnose were included.LNG-IUS were inserted in the patients at the 5-7th day of menstrual cycle or after dilatation and curettage.We compared menstrual blood loss,the endometrial thickness and pathologic changes of endometrial before and after 3,6,12,24 months of treatment.Hemoglobin levels were also recorded at the same time.Results Menstrual blood loss was decreased significantly after insertion.There was significant difference between mean PBAC scores before and after 12 months follow-up,with those of scores dropping from 131.4±48.1 to 28.2±7.1(P<0.001).Hemoglobin of all cases was significantly increased from 78.76±11.80g/L to 124.20±7.28g/L(P<0.001).The endometrium became thinner and the thickness of endometrium was reduced from 15.68±4.11mm to 4.98±0.68mm(P<0.001).Pathological examination demonstrated that endometrial hyperplasia regressed and exhibited visible secretion and pseudo-decidual reaction in all cases.Conclusion LNG-IUS is an effective,safe and non-operative therapy in the treatment of obstinate dysfunctional uterine bleeding with few side effects.It can not only decrease menstrual blood loss but also reverse the endometrial hyperplasia.