曼月乐治疗功能失调性子宫出血的临床观察

目的：观察曼月乐对功能失调性子宫出血的临床疗效.方法：对60例门诊确诊为功能失调性子宫出血的患者放置曼月乐,放置后3,6,12个月观察患者月经改变、血红蛋白改变、子宫内膜厚度变化情况.结果：置环后12个月经量明显减少,与置环前比较差异有统计学意义（P＜0.05）;血红蛋白置环后6个月明显上升,与放置前比较差异有统计学意义（P＜0.05）;子宫内膜厚度放置曼月乐12个月后由（16.5±7.3） mm减至（3.1±1.4） mm,与放置前比较有显著差异（P＜0.05）.结论：曼月乐对功能失调性子宫出血治疗有较好的疗效.     

绝经过渡期功血患者刮宫后行曼月乐与米非司酮间断给药对子宫内膜厚度、性激素的影响观察

目的:观察绝经过渡期功血患者刮宫后行曼月乐与米非司酮间断给药对子宫内膜厚度、性激素的影响.方法:将2013年2月~2015年6月来我院治疗绝经过渡期功血的患者104例,按照完全随机的原则将其均分为观察组和对照组;刮宫术后5天,观察组行曼月乐置入治疗,对照组给予米非司酮间断口服治疗;观察两组患者的临床疗效,治疗前后子宫内膜厚度、月经量、血红蛋白浓度及性激素变化情况,不良反应发生率.结果:观察组的临床有效率(88.46%)显著高于对照组(59.62%),差异具体统计学意义.治疗后两组患者的子宫内膜厚度、月经量、血红蛋白浓度、FSH、E2、PRL、LH、P均有改善,但观察组患者各项指标的改善情况均显著优于对照组,差异具有统计学意义.对照组不良反应发生率(11.54%)显著高于观察组(42.31%),差异具有统计学意义.结论:曼月乐和米非司酮间断给药治疗方式治疗围绝经期功血均具有一定的临床疗效,其中曼月乐的临床疗效更加显著,不良反应发生率低,安全性高,值得临床上推广.     

Serum and peritoneal fluid levels of levonorgestrel in women with endometriosis who were treated with an intrauterine contraceptive device containing levonorgestrel

OBJECTIVE: To determine and compare levels of levonorgestrel (Lng) in serum and peritoneal fluid (PF) of patients on the Lng intrauterine system Mirena (Schering Health, Berlin, Germany) for endometriosis and to relate these to symptoms. DESIGN: Prospective clinical trial. SETTING: Gynecology unit of a teaching hospital. PATIENT(S): Women with minimal to moderate endometriosis at diagnostic laparoscopy. INTERVENTION(S): Mirena was inserted at diagnostic laparoscopy and blood and PF collected for Lng levels. Levonorgestrel was again quantified in serum at 1, 3, and 6 months and PF at 6 months. MAIN OUTCOME MEASURE(S): Serum and PF Lng levels during 6 months, differences in levels before and 6 months after Mirena insertion, and the relationship between these levels and symptoms of endometriosis. RESULT(S): There was significant improvement in symptoms after 6 months on Mirena. The mean (SD) serum Lng levels were 459.2 (100.2), 368.2 (51.8), and 357.3 (53.0) pg/mL at 1, 3, and 6 months, respectively. The PF levels at 6 months were approximately two-thirds the serum levels in patients showing improvement in symptoms. CONCLUSION(S): Mirena delivers significant amounts of Lng into the PF and serum. The relationship between Lng levels in these compartments is linear.     

Endometrial adenocarcinoma following insertion of the levonorgestrel-releasing intrauterine system (mirena) in a 36-year-old woman

The levonorgestrel-releasing intrauterine system (LNG-IUS), commonly referred to as mirena, is an effective form of contraception, which is widely used as an intrauterine device. It has a 32-mm long-shaped plastic frame that holds a reservoir (on the vertical stem) of 52 mg of levonorgestrel mixed with polydimethylsiloxane to allow a steady release of 20 mug of levonorgestrel per day within the endometrial cavity through a rate-limiting surface membrane. Apart from contraceptive purpose, it is also now commonly used in the management of heavy menstrual blood loss. This study included a 36-year old woman who developed endometrial cancer following the insertion of the LNG-IUS. Her main presentation was irregular vaginal bleeding, which is a common finding in women using this form of contraception. Although we would advice caution in investigating such women, the LNG-IUS remains a relatively safe method of contraception.     

预防子宫内膜息肉术后复发的疗效观察

目的:比较3种不同方法预防子宫内膜息肉(EMP)宫腔镜手术后复发的疗效。方法:选择行宫腔镜下子宫内膜息肉电切术(TCRP)患者194例,术后分为对照组和3组治疗组,分别为:安宫黄体酮组术后给予安宫黄体酮片周期性治疗3～6个月,妈富隆组术后给予妈富隆片周期性治疗3～6个月,曼月乐组术后给予放置左炔诺孕酮宫内缓释系统,随访观察时间>24个月,观察各组子宫内膜息肉复发的情况。结果:对照组58例中EMP复发14例(复发率24.1%),安宫黄体酮组45例中EMP复发4例(复发率8.9%),妈富隆组59例中复发5例(复发率8.4%),曼月乐组32例中复发2例(复发率6.3%),3组治疗组分别与对照组比较,差异均有统计学意义(P<0.05);3组治疗组之间相互比较,差异均无统计学意义(P>0.05)。医疗费用方面3组治疗组相互比较,安宫黄体酮组与妈富隆组比较无统计学意义(P>0.05),曼月乐组分别与安宫黄体酮组、妈富隆组相互比较均有统计学意义,其医疗费用明显高于安宫黄体酮组和妈富隆组(P<0.05)。结论:子宫内膜息肉患者行TCRP术后,应用安宫黄体酮片、妈富隆片或曼月乐均有助于降低子宫内膜息肉的复发,故临床上可根据患者...     

曼月乐对子宫腺肌症患者痛经及经量增多的治疗效果分析

目的：探讨左诺孕酮宫内缓释系统（曼月乐）治疗子宫腺肌症患者痛经及经量增多的临床疗效。方法选取长江航运总医院收治的48例子宫腺肌症患者,随机均分为对照组（口服甲睾酮）和观察组（放置曼月乐环）,比较两组患者治疗前后痛经程度、月经量和不良反应发生率的差异。结果两组患者治疗后痛经症状减轻,月经量减少,均较治疗前有不同程度改善,差异有统计学意义（P＜0．05）,观察组改善程度明显优于对照组,差异有统计学意义（P＜0．05）;两组患者均无严重不良反应发生,不良反应发生率比较差异无统计学意义（P＞0．05）。结论曼月乐治疗子宫腺肌症患者效果确切,可有效缓解痛经和月经量多等临床症状,无严重不良反应,值得临床广泛推广使用。     

The evaluation of the effectiveness of an intrauterine-administered progestogen (levonorgestrel) in the symptomatic treatment of endometriosis and in the staging of the disease

BACKGROUND: Medical treatment of endometriosis, a condition which significantly affects the quality of life in approximately 10-15% of women in the reproductive years, remains problematic. Although oral progestogens are effective and cheap, their efficacy is significantly influenced by poor compliance and systemic side effects. A progestogen (levonorgestrel) administered via an intrauterine system (Lng-IUS) has been demonstrated to improve symptoms of endometriosis; however, its effect on the staging of the disease has not been evaluated. The aims of this study were therefore to investigate the effectiveness of Lng-IUS in the symptomatic relief of minimal to moderate endometriosis and in the staging of the disease. METHODS: This was a prospective non-comparative observational study in which 34 women with clinically suspected and laparoscopically confirmed symptomatic minimal to moderate endometriosis had Lng-IUS inserted for 6 months. The symptom profile and stage of the disease before, during and after 6 months of treatment and patients' satisfaction with treatment and willingness to retain the device at the end of the study period were used to assess response to treatment. RESULTS: Of the 34 women recruited, 29 (85%) completed the study; five discontinued, for personal reasons (one), side effects of worsening of acne (one) and lower abdominal/ pelvic pain (three). Significant (P<0.05) improvements in severity and frequency of pain and menstrual symptoms as well as staging were achieved, with 68% (23) of cases electing to continue with the device after 6 months of therapy. CONCLUSION: The levonorgestrel intrauterine system is an effective hormonal option for treating symptomatic endometriosis (minimal to moderate). It also alters the American Fertility Society staging of disease. With a continuation rate of 68% after 6 months, it has the potential for providing long-term therapy in a substantial number of sufferers, although this would require further study and verification.     

宫内放置曼月乐治疗子宫腺肌病的临床疗效分析

[目的]探讨左炔诺孕酮宫内缓释系统(LNG-IUS;商品名:曼月乐)在治疗子宫腺肌病中的临床疗效。[方法]将60例在我院确诊并有手术指征的子宫腺肌病患者随机分成两组,手术组和放置曼月乐组,每组30例。比较两组治疗后内分泌、性生活、盆腔疼痛的改变,曼月乐组治疗前后在痛经程度,经量,经期及血清CA125等临床指标的变化。[结果](1)手术组在手术后6个月测定的FSH值较手术前明显升高,差异呈显著性(P<0.01),放置曼月乐组在放置后6个月测定的FSH值与放置前比较均无统计学差异(P>0.05)。手术组6个月后测定的FSH明显高于曼月乐组,差异呈显著性(P<0.01);(2)曼月乐组放置后6个月性生活质量明显优于手术组,盆腔疼痛症状明显小于手术组,差异呈显著性(P<0.01);(3)放置曼月乐后痛经症状明显缓解,经量明显减少,经期缩短,血清CA125降低,差异有统计学意义(P<0.01)。[结论]曼月乐治疗子宫腺肌病切实有效,值得临床推广。