促性腺激素释放激素激动剂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

目的探讨促性腺激素释放激素激动剂（GnRH—a）联合左炔诺孕酮宫内缓释系统（LNG—IUS）在治疗子宫腺肌病中的作用。方法回顾性分析45例子宫腺肌病患者（宫腔深度超过11cm）的临床病理资料，其中26例患者接受GnRH—a针3．6mg。每4周1次，并在第3次注射后放置LNG—IUS环联合治疗设为观察组．19例患者接受了月经来潮7d内放置LNG—IUS环设为对照组。分别统计两组痛经患者治疗前、治疗后3个月、6个月、12个月、2年时的患者的痛经缓解程度，月经过多的患者血红蛋白变化及两组患者子宫体积变化、LNG—IUS环下移率、阴道点滴出血并发症是否有差异。结果观察组中随着治疗时间延长，患者痛经的临床缓解率逐渐提高，但与对照组比较，差异均无统计学意义（X^2分别=0．23、0．12、0．23、1．46，P均〉0．05）；观察组患者血红蛋白逐渐上升，与治疗前比较，差异均有统计学意义（t分别=2_49、3．12、3．14、3．07，P均〈0．05）；观察组中经过治疗后，复查B超子宫体积明显缩小，与治疗前比较，差异均有统计学意义（t分别=1．87、1．81、2．02、2．32，P均〈0．05），观察组在治疗后3个月时观察组的子宫体积明显小于对照组，差异有统计学差异（￡：1．93，P〈0．05）．而治疗后6个月起子宫体积大小差异不明显，差异均无统计学意义（t分别：1．02、1．53、1．36，P均〉0．05）；观察组出现LNG—IUS环下移及脱落和引起阴道点滴出血情况明显少于观察组，差异均有统计学差异（X^2分别=5．83、4．18，JP均〈0．05）。结论联合GnRH—a与LNG—IUSg可有效治疗大子宫腺肌病合并疼痛与月经过多，并可减少在大子宫中LNG—IUS环下移、阴道点滴出血等并发症。

Clinical research of GnRH-a combined with LNG-IUS in treating adenomyosis

Objective To observe the clinical effect of gonadotropin releasing hormone agonist（GnRH-a） combined with the levonorgestrel-releasing intrauterine system（LNG-IUS） in treating adenomyosis. Methods Made a retrospective analysis of the clinical and pathological data of 45 cases of patients with adenomyosis whose uterine cavity depth was longer than 1 lcm. Treatment group （n=26） received goserelin 3.6 mg, once four weeks. After the third injection, LNG-IUS was used. Control group（n=19） only placed LNG-IUS in 7 days of menses. The dysmenorrhea relief degree, hemoglobin change, uterine volume change, the rate of LNG-IUS ring dropped and vaginal bleeding of dysmenorrhea patients before treatment and after treatment for 3 months, 6 months, 12 months and 2 years were compared between two groups. Results With the treatment time extension, the dysmenorrhea relief rate of treatment group gradually increased. Compared with the control group, the differences were not statistically significant （X^2=0.23,0.12,0.23,1.46, P〉 0.05 ）. Compared with prior treatment, the levels of hemoglobin after treatment of treatment group increased significantly （t=2.49,3.12,3.14,3.07 ,P〈0.05）. Com- pared with prior treatment, The uterine volume of treatment group was significantly reduced after treatment （t = 1.87,1.81,2.02,2.32,P〈0.05）. Uterine volume of the treatment group in 3 months after treatment was less than that of the control group, the difference was statistically significant （t=1.93, P〈0.05） while the difference between two group was not statistically significant in 6 months, 12 months and 2 years after treatment （t=1.02, 1.53,1.36,P〉0.05）. The rate of the LNG-IUS ring down, fall off and vaginal bleeding of treatment group were lower than the control group, the differences were statistically significant （X^2=5.83,4.18,P〈0.05）. Conclusions GnRH-a combined with LNG-IUS is an effective mothod in the treatment of adenomyosis with dysmenorrhea and hypermenorrhea. It also can reduce the rate of vaginal bleeding and LNG-IUS down ocurring in large uterus.