卵巢子宫内膜异位囊肿剥除术后放置左炔诺孕酮宫内节育器的临床观察

目的:探讨卵巢子宫内膜异位囊肿剥除术后宫腔放置左炔诺孕酮宫内节育器(LNG-IUS)的临床疗效。方法:选择2006年6月~2008年4月在该院施行卵巢子宫内膜异位囊肿剥除术的患者,31例为术后放置LNG-IUS(LNG-IUS组),30例为术后口服孕三烯酮(对照组),比较术前VAS3分者治疗后VAS的评分变化及观察复发情况等。结果:LNG-IUS组平均VAS评分由术前的(6.45±0.47)分分别降至治疗3个月及6个月后的(1.65±0.36)分和(1.85±0.48)分,治疗3个月和6个月与术前VAS评分比较有统计学差异(P0.01),但与孕三烯酮组比较差异无统计学意义(P=0.611,P=0.462);治疗1年LNG-IUS组与对照组中重度痛经的发生率分别为12.90%(4/31)和30.00%(9/30),两组复发率分别为19.35%(6/31)和33.33%(10/30),中重度痛经的发生率和复发率两组比较无统计学差异(P=0.623,P=0.255)。愿意继续接受治疗的LNG-IUS组(87.10%)明显高于对照组(46.67%),差异有统计学意义(P0.01)。结论:LNG-IUS可有效缓解卵巢子宫内膜异位囊肿的相关疼痛,有较好的依从性,可作为内异症保守性手术后预防或延缓复发的辅助性治疗方法。     

左炔诺孕酮宫内缓释系统治疗子宫内膜异位症的临床效果观察

目的观察左炔诺孕酮宫内缓释系统治疗子宫内膜异位症的临床疗效及安全性。方法 51例患者在第1个月月经来潮后第2~5天,按照操作指南由专人行宫内放置LNG-IUS术（德国拜耳公司产品）。结果 24个月后,与放置LNG-IUS前相比,51例患者的痛经全部得到改善。痛经、性交痛、慢性盆腔痛评分显著下降,差异有统计学意义（P〈0.05）;子宫体积、盆腔囊肿体积、子宫内膜厚度、血CA125明显下降,差异有统计学意义（P〈0.05）;血红蛋白值显著升高,差异亦有统计学意义（P〈0.01）。不良反应：出现痤疮7例,月经间期出血12例,全身肿胀2例,面部色素沉着2例,脱发1例。结论放置左炔诺孕酮宫内缓释系统可抑制子宫内膜增长,改善患者痛经、性交痛、慢性盆腔痛等临床症状,副作用少,对子宫内膜异位症安全、有效。     

左炔诺孕酮宫内缓释系统治疗子宫内膜异位症的临床观察

目的 使用左炔诺孕酮官内缓释系统(LNG-IUS)治疗子宫内膜异位症(EMS)并评价其疗效.方法 对53例EMS患者于经期末官腔放置LNG-IUS,放置后3、6、12个月观察其疗效,并进行比较.结果 放置LNG-IUS后3、6、12个月患者痛经、深部性交痛、经期肛门抽痛评分均较放置前显著降低(P＜0.05).放置后12个月CA125[(21.8±12.5)kU/L]及雌二醇[(78.8±45.5)ne/L]较放置前及放置后3、6个月明显改善[CA125:(36.3±17.5)、(33.5±15.6)、(28.2±11.7)kU/L,雌二醇:(40.4±28.6)、(42.5±31.5)、(56.5±36.2)ng/L](P＜0.05).放置后6、12个月患者月经量较放置前明显减少(P＜0.05),生活质量明显改善(P＜0.05).结论 LNG-IUS作为释放微量孕激素的缓释系统可以安全有效地治疗EMS,不良反应小.

Abstract：

Objective To evaluate the efficacy of levonorgestrel-releasing intrauterine system(LNGIUS) in the treatment of endometriosis. Methods Fifty-three patients suffering from endometriosis were placed LNG-IUS in uterine cavity after menstruation. The efficacy 3,6,12 months after LNG-IUS placement was observed and compared. Results The scores of dysmenorrhea, deep dyspareunia, menstrual anus pain 3,6,12 months after LNG-IUS placement were lower than those before LNG-IUS placement (P ＜ 0.05 ).CA125 [(21.8±12.5) kU/L]and destradiol [(78.8±45.5)ng/L] 12 months after LNG-IUS placement were improved than those before LNG-IUS placement and 3,6 months after LNG-IUS placement [CA 125:(36.3±17.5), (33.5±15.6), (28.2 ± 11.7) kU/L,destradiol: (40.4 ± 28.6), (42.5 ± 31.5), (56.5 ± 36.2) ng/L](P ＜ 0.05 ). The menstrual blood volume was less 6,12 months after LNG-IUS placement than that before LNG-IUS placement (P＜0.05), and the quality of life was improved( P ＜ 0.05 ). Conclusion LNG-IUS can be safe and effective treatment of patients with endometriosis, and less side effects.     

左炔诺孕酮宫内缓释系统治疗子宫内膜异位症的临床观察

目的:观察左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫内膜异位症(Endometriosis EM)及子宫腺肌病(Adenomyosis AM)的临床效果和不良反应。方法:对59例诊断为AM或EM的患者放置LNG-IUS,观察放置前、放置后6个月及12个月的痛经评分、子宫体积、内膜厚度等指标。结果:与放置LNG-IUS前相比,59例患者在放置6、12个月后痛经、性交痛、慢性盆腔痛评分、月经失血量、CA125水平、子宫内膜厚度均明显下降,差异有统计学意义(P<0.01)。血红蛋白值显著升高,差异亦有统计学意义(P<0.01)。子宫体积、盆腔囊肿体积差异无统计学意义(P>0.05)。随访12个月后,59例患者中14例仍有月经间期出血。结论:LNG-IUS可有效改善AM及EM患者临床症状,月经间期出血是常见的不良反应。     

左炔诺孕酮宫内缓释系统用于子宫内膜异位症术后的临床观察

<正>子宫内膜异位症(EMT)虽为良性病变,但可引起盆腔疼痛、月经失调及不孕,严重困扰着妇女的身心健康。EMT保守性手术后患者多采用口服药物巩固治疗,以预防复发。但由于药物都有副作用,降低了患者的依从性,增加了EMT术后复发率。笔者对56例EMT保守性术后患者采用放置左炔诺孕酮     

左炔诺孕酮宫内缓释系统与长效醋酸甲羟孕酮治疗子宫内膜异位症的临床疗效

目的:比较左炔诺孕酮宫内缓释系统(LNG-IUS)与长效醋酸甲羟孕酮(Depot-MPA)治疗子宫内膜异位症的临床疗效。方法:保守性手术后即刻或单纯疼痛复发后患者87例,42例放置LNG-IUS,45例在3年内每隔3个月肌注长效醋酸甲羟孕酮(Depot-MPA)150 mg,比较临床症状控制情况、复发率、依从性、骨密度。结果:两种治疗方案均能控制临床疼痛症状及复发率。LNG-IUS治疗组患者依从性优于长效醋酸甲羟孕酮治疗组。LNG-IUS治疗组腰椎及股骨颈Wards三角区骨密度(BMD)变化幅度比长效醋酸甲羟孕酮治疗组大。结论:LNG-IUS治疗组可以有效地控制子宫内症膜异位症的临床症状和复发率,患者依从性好,骨密度可以得到改善,而长效醋酸甲羟孕酮治疗组出现骨密度下降。     

左炔诺孕酮宫内缓释系统的临床应用

左炔诺孕酮宫内缓释系统(levonorgestrel releasing intrauterine system,LNG-IUS)是一种新型的宫内避孕系统,每天向宫腔内释放一定量的左炔诺孕酮发挥作用。随着对LNG-IUS的应用发现其不但具有长期、高效的避孕作用,在非避孕领域中也具有新功能,尤其在子宫内膜异位症、子宫腺肌病、痛经、子宫内膜增生等妇科疾病的治疗中,具有重要意义。     

宫腔镜子宫内膜切除联合左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

目的:观察宫腔镜子宫内膜切除(TCRE)联合左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫腺肌病患者的疗效。方法:选择无生育要求且欲保留子宫的腺肌病患者43例,研究组20例,先行宫腔镜子宫内膜切除术之后再放置曼月乐;对照组23例单纯放置曼月乐。治疗后定期随访了解患者月经状况,以VAS视觉评分评估其痛经状况,并进行阴道超声及妇科检查。结果:两组治疗前后在控制月经过多及痛经方面均效果显著。组间比较显示,治疗后3个月、半年及1年的阴道不规则出血率及闭经率比较有统计学差异(P<0.001),但两组间疼痛缓解状况比较无统计学差异(P=0.061)。结论:宫腔镜子宫内膜切除联合左炔诺孕酮宫内缓释系统治疗子宫腺肌病可以有效防止单纯放置曼月乐所引起的淋漓出血,同时可以防止TCRE术后各种并发症的发生。     

GnRH-a联合LNG-IUS治疗子宫内膜异位症腹腔镜术后效果分析

目的:探讨中、重度子宫内膜异位症腹腔镜手术后应用促性腺激素释放激素激动剂(GnRHa)、左炔诺孕酮宫内缓释系统(LNG-IUS)、GnRH-a+LNG-IUS后续治疗的效果.方法:回顾性分析腹腔镜保守性手术切除证实盆腔子宫内膜异位症的117例患者的临床资料,根据患者选择情况分组:术后单纯应用GnRH-a组30例(A组),术后应用左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)治疗组43例(B组),应用GnRH-a+LNG-IUS组44例(C组).在手术前及手术后第3、6、12、24个月随访观察痛经评分、血清糖类抗原CA125水平、月经改变、手术后复发率等多项指标.结果:三组手术后随访2年,痛经评分及血清CA125水平均较术前明显降低,A组与C组术后均应用GnRH-a,在随访的3个月、6个月时痛经评分与B组比较有统计学意义(P＜0.05).随访2年内,三组内异囊肿复发率分别为33.33％,9.30％,9.09％,B组与C组月经改变比较,B组在放置曼月乐半年内不规则出血、经期延长发生率高于C组,但放置曼月乐1年、2年后差异无统计学意义.结论:内异症保守性手术后预防复发,从长期用药考虑联合LNG-IUS和GnRH-a+LNG-IUS均有效地缓解疼痛症状,降低血清CA125水平,缩小卵巢内异症囊肿体积,是一种有效、安全、持续时间长、全身不良作用少、依从性高的治疗方法.     

左炔诺孕酮宫内缓释系统对子宫内膜增生性疾病的治疗

<正>左炔诺孕酮宫内释放系统(LNG-IUS,商品名曼月乐)是一种有效的避孕药具,在应用的过程中,人们发现其还可用于治疗月经过多、子宫内膜异位症、子宫内膜增生性疾病等,本文仅就LNG-IUS治疗子宫内膜增生性疾病做以下综述。     

Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration

Background

The objective of this study was to assess the effect of timing of postpartum levonorgestrel-releasing intrauterine device (IUD) insertion on breast-feeding continuation.

Study Design

Women interested in using a levonorgestrel IUD postpartum were randomized to immediate postplacental insertion (postplacental group) or insertion 6–8 weeks after vaginal delivery (delayed group). Duration and exclusivity of breast-feeding were assessed at 6–8 weeks, 3 months, and 6 months postpartum. Only women who received an IUD were included in this analysis.

Results

Breast-feeding was initiated by 32 (64%) of 50 of women receiving a postplacental IUD and 27 (58.7%) of 46 of women receiving a delayed IUD (p=.59). More women in the delayed group compared with the postplacental group continued to breast-feed at 6–8 weeks (16/46 vs. 15/50, p=.62), 3 months (13/46 vs. 7/50, p=.13), and 6 months postpartum (11/46 vs. 3/50, p=.02). The results did not differ when only women who initiated breast-feeding or only primiparous women with no prior breast-feeding experience were analyzed.

Conclusions

Immediate postplacental insertion of the levonorgestrel IUD is associated with shorter duration of breast-feeding and less exclusive breast-feeding. Further studies on the effects of early initiation of progestin-only methods on women's lactation experience are needed.     

Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods

Women seeking legal first trimester abortion were counseled concerning contraception methods available for use immediately postabortion. Fifty women each accepted hormonal methods that were available only in the clinic and were novel to the country, the levonorgestrel IUD and Norplant implants, whereas another 50 chose either coitus interruptus or abstinence. All were experienced contraceptors, but larger percentages of women selecting the levonorgestrel IUD or implants had used the pill or IUDs previously, were under age 30, and weighed less than 60 kg compared to the other study participants. In the initial 2–6 weeks postabortion, women using the long-acting hormonal methods resumed sexual activity earlier and experienced more bleeding and spotting days than did other study participants, but their hematocrits were not adversely affected. No clinically significant side effects were noted in any group in the 6 weeks following the abortion. At the end of 1 year of follow-up, women using the hormonal methods had experienced no pregnancies and had high rates of continuation. IUD and implant participants had greater weight gain than did the other participants, but their mean weight remained below that of participants using traditional methods. No significant between-group differences in levels or changes in levels from admission were noted in hematocrit and blood pressure. The women found the levonorgestrel implants and IUDs easy and safe to use and highly effective. Bleeding disturbances, including amenorrhea, were the principal features the women disliked.     

A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device

BACKGROUND: Postplacental intrauterine device (IUD) insertion is a safe, convenient and effective option for postpartum contraception. Few studies involve ultrasound-guided insertion, and none involve the levonorgestrel IUD or take place in the United States. STUDY DESIGN: The study was conducted to assess the safety and feasibility of ultrasound-guided postplacental insertion of the levonorgestrel IUD following vaginal delivery in a U.S. residency program. Levonorgestrel IUDs were inserted under ultrasound guidance within 10 min of placental delivery by hand or using ring forceps. Subjects were examined at 4 and 10 weeks postpartum for evidence of expulsion or infection. RESULTS: Thirty-four subjects were enrolled and 20 received an IUD. Follow-up data are available for 19 subjects over the 10-week follow-up period; 16 subjects returned for the 4-week follow-up, and 14 returned at 10 weeks. Two additional subjects could be contacted by telephone only. At 4 and 10 weeks postpartum, no subjects had evidence of infection. There were two expulsions (2/19, 10.5%) by 10 weeks postpartum. None of the subjects examined had a partial expulsion (intracervical location of the IUD). CONCLUSIONS: In this pilot study, ultrasound-guided postplacental insertion of the levonorgestrel IUD was feasible and not associated with infection. The risk of expulsion was acceptable. Ultrasound-guided postplacental insertion of the levonorgestrel IUD may be an alternative to delayed insertion but warrants further study.     

Term pregnancy with intraperitoneal levonorgestrel intrauterine system: a case report and review of the literature

Background

The risk of adverse effects of fetal exposure to the levonorgestrel intrauterine system (LNG-IUS) has not been established.

Study Design

In this case report and literature review, we describe a pregnant patient with an intraperitoneal LNG-IUS and the subsequent maternal and neonatal outcomes. A systematic literature search was performed to identify similar clinical reports. The MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, Web of Science and Scopus databases were searched from inception through March 2007.

Results

The pregnancy progressed uneventfully and culminated in the elective cesarean delivery of a full-term healthy boy. Of the 35 pregnancies identified in the literature review (34 pregnancies with intrauterine LNG-IUS and 1 term delivery with intraperitoneal LNG-IUS), congenital anomalies were reported in 2 infants (6%).

Conclusions

Fetal exposure to LNG-IUS is associated with a low frequency of congenital anomalies.     

Serum levonorgestrel levels and endometrial thickness during extended use of the levonorgestrel-releasing intrauterine system

Background

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a contraceptive method approved for five years of use. However, there is some evidence that its life span may be longer. The aim of the study was to evaluate serum levonorgestrel (LNG) and estradiol (E₂) levels and endometrial thickness every 6 months from 7 to 8 1/2 years after insertion.

Study Design

At the end of the approved 5-year life span, no replacement devices were available; therefore, 86 women were allowed to retain the same device for a further 2 years. At the 7-year follow-up visit, the women who consented were again allowed to retain the same device for a further 18 months and were followed-up at six-monthly intervals. At each visit, vaginal sonography was performed to measure endometrial thickness, and a blood sample was taken to measure LNG and E₂.

Results

Eighty-four months after insertion, 67 women aged 34.3±0.8 years (mean±SEM) (range, 25-49 years) returned for follow-up. Mean±SEM LNG levels decreased from an initial 253±27 pg/mL (range, 86-760) during the first 2 months following insertion to 137±12 (range, 23-393) at 84 months and 119±9 pg/mL (range, 110-129) at 102 months of use (±SEM). At 84 months of use, mean±SEM endometrial thickness was 2.8±0.1 mm, increasing to 3.8±0.5 mm at 102 months of use. The incidence of amenorrhea decreased from 41.8% at 84 months to 31.5% at 102 months of use. No correlation was found between LNG levels and bleeding patterns; however, a weak correlation was found between high body mass index (kg/m²), high weight, and low serum LNG levels. E₂ levels were similar to those of the follicular phase of the menstrual cycle of regularly menstruating women.

Conclusions

During extended use of the LNG-IUS, serum LNG levels were nearly half those found in the first 2 months of use (Wilcoxon signed rank test); serum E₂ levels were normal. Despite the very thin endometrium, menstrual bleeding was reinstated in many cases. At the end of its 5-year life span, there is a window for changing the LNG-IUS, and physicians and users should not be concerned about delaying replacement of the device for a short time beyond the approved life span; however, maintaining the same device long after its approved life span cannot be recommended.     

腹腔镜术后辅助GnRH-a治疗子宫内膜异位症的临床疗效观察

目的:观察腹腔镜术后辅助GnRH-a治疗子宫内膜异位症的临床疗效,探讨治疗子宫内膜异位症的最佳治疗方案。方法:选择采用腹腔镜治疗术后确诊为子宫内膜异位症患者126例,按照自愿的原则分为对照组与观察组,对照组53例术后未采用辅助治疗,观察组73例术后辅助GnRH-a治疗12个月后比较两组患者治疗前后生殖激素水平变化、总主观症状评分及临床疗效。结果:治疗12个月后,两组患者治疗后生殖激素水平、总主观症状评分及临床疗效方面比较差异有统计学意义(P<0.05)。结论:外科治疗子宫内膜异位症时应术后辅助GnRH-a治疗,可提高临床疗效、减少复发。     

Amenorrhea rates and predictors during 1 year of levonorgestrel 52 mg intrauterine system use

Objective

The objective was to evaluate amenorrhea patterns and predictors of amenorrhea during the first year after levonorgestrel 52 mg intrauterine system (IUS) placement.

Endometrial vascularization in levonorgestrel intrauterine device users; computerized microvessel measurement study

Levonorgestrel use in the levonorgestrel intrauterine device (LNG-IUS) induces vascular distension within the superficial layer of the endometrium and massive pseudodecidualization. With a computer-assisted image analysis system, we objectively measured the vascular bed in LNG-IUS users and compared it to the physiological endometrium. A study was undertaken on 25 women using LNG-IUS, in an outpatient procedure at the time of removal of the IUS and compared with 11 normally cycling women (control group). Suction curette specimens were obtained just after retrieval of the IUS, and immunohistochemistry was carried out with a specific marker of the endothelial cells (CD31). Number of vessels decreased in the LNG-IUS group to 60/mm2 versus 124/mm2 in the control group, and mean vessel area increased to 1255 microm2 versus 157 microm2, respectively, in the control group. The decrease in mean vascular density and the increase of mean vessel area in the LNG-IUS group, compared to the control group, were both highly significant (p<.001).