左炔诺孕酮宫内缓释系统治疗子宫内膜单纯性增生过长的研究

目的：探讨左炔诺孕酮宫内缓释系统（曼月乐）治疗子宫内膜单纯性增生过长的疗效及可能作用机制。方法：选取 2011年11月—2012年2月门诊应用曼月乐治疗子宫内膜单纯性增生过长的患者60例，观察放置曼月乐6个月后的子宫内膜活检病理变化及经阴道超声测量子宫内膜厚度、子宫动脉血流[阻力指数（RI）、搏动指数（PI）]及月经模式的改变。结果：2例由于阴道持续性点滴出血提前取出，58例子宫内膜转归正常。放置曼月乐前后子宫内膜厚度、RI分别为（1.52±0.33） cm、（0.62±0.14）cm和0.64±0.07、0.79±0.08，差异均有统计学意义（P＜0.05或P＜0.01），PI分别为1.98±0.51、1.96±0.04，差异无统计学意义（P＞0.05)。放置曼月乐后经量明显减少，24例表现为月经稀发，32例表现为闭经。结论：曼月乐是治疗子宫内膜单纯性增生过长的简单有效方法，对子宫动脉血流的影响是其可能的作用机制。

Study of Levonorgestrel Intrauterine System in the Treatment of Simple Endometrial Hyperplasia

Objective：To study the efficancy and long possible mechanism of Mirena（levonorgestrel intrauterine system）in the treatment of simple endometrial hyperplasia. Methods：Select sixty cases of simple endometrial hyperplasia in outpatient between 2011.11 and 2012.2，we observed the menstrual patterns，the endometrial thickness and uterine arterial blood flow [resistance index（RI），pulsatility index（PI）] by transvaginal ultrasound，pathologic changes of endometrial by endometrial biopsy in 6 months after insertion of mirena. Results：2 patients were removed Mirena due to colporrhagia. Pathological examinations of 58 patients performed 6 months after the insertion showed that endometrial hyperplasia had reversed. The endometrial thickness，RI of uterine artery in 6 months after the insertion were statistically significant，respectively（1.52±0.33） cm，（0.62±0.14） cm（P＜0.05） and 0.64±0.07，0.79±0.08（P＜0.01）；PI was 1.98±0.51，1.96±0.04，the difference was not statistically significant（P＞0.05）. After placing Mirena significantly reduced by the amount，24 cases showed oligomenorrhea，32 cases showed amenorrhea. Conclusions：Mirena is an efficient and simple treatment of simple endometrial hyperplasia. The influence of uterine arterie blood flow is its possible mechanism.