宫腔镜子宫内膜去除术联合孕三烯酮治疗子宫肌腺症的临床研究

目的:探讨宫腔镜子宫肌内膜切除联合孕三烯酮治疗子宫腺肌病的临床价值。方法:将63例子宫肌腺症患者随机分为研究组42例和对照组21例。两组均采用宫腔镜下子宫内膜电切术(TCRE)切除子宫内膜全层基底膜及其下方部分肌层组织,研究组术后予孕三烯酮治疗12个月。两组术后均随访24个月,观察月经量、血红蛋白水平、痛经评分、子宫体积、血CA125、复发率和并发症。结果:术后随访24个月,研究组的月经量、血红蛋白水平、痛经评分、子宫体积与对照组比较差异有统计学意义(P<0.01),子宫体积缩小程度明显优于对照组(P<0.01),血CA125下降值两组比较差异有统计学意义(P<0.01);复发率(50.00%)明显低于对照组(13.97%)(P<0.01)。研究组患者的并发症主要为孕三烯酮所致轻度肝功能异常。结论:宫腔镜子宫肌腺病内膜切除联合孕三烯酮治疗子宫腺肌病安全、疗效显著、复发率低,是保守治疗子宫肌腺症的有效方式。

Clinical study on hysteroscopic endometrial resection combined with gestrinone for treatment of adenomyosis

Objective:To explore the clinical value of hysteroscopic endometrial resection combined with gestrinone for treatment of adenomyosis.Methods:Sixty-three patients with adenomyosis were randomly divided into study group(42 patients) and control group(21 patients).The patients in the two groups were treated with transcervical resection of endometrium(TCRE) to resect basement membrane and partial muscular tissue of endometrium,the patients in study group were also treated with gestrinone for 12 months.All the patients in the two groups were followed up for 24 months after TCRE;the menstrual volumes,hemoglobin levels,dysmenorrheal scores,uterine volumes,blood CA125 levels,recurrence rates,and complications in the two groups were observed.Results:There were statistically significant differences in menstrual volume,hemoglobin level,dysmenorrheal score,uterine volume between study group and control group(P<0.01),the degree of reduction of uterine volume in study group was statistically significantly higher than that in control group(P<0.01),there was statistically significant difference in decreasing value of blood CA125 between the two groups(P<0.01);the recurrence rate in study group was 50.00%,which was statistically significantly lower than that in control group(13.97%)(P<0.01).The major complication in study group was gestrinone-induced mild dysfunction of liver.Conclusion:Hysteroscopic endometrial resection combined with gestrinone is safe for treatment of adenomyosis,the curative effect is dominant,and the recurrence rate is low,which is an effective method for conservative treatment of adenomyosis.