射频消融术联合左炔诺孕酮宫内节育系统治疗子宫腺肌病

目的探讨射频消融术联合左炔诺孕酮宫内节育系统（LNG—IUS）治疗子宫腺肌病的临床应用价值。方法对我院2007年4月-2009年4月诊断为子宫腺肌病的62例随机分为观察组36例（射频消融术＋宫内放置LNG—IUS）和对照组26例（仅宫内放置LNG—IUS）。术后1、3、6、12个月随访观察痛经改善程度、闭经率、月经量、子宫大小、血清癌抗原（CA）125值。结果观察组在痛经改善率、闭经率、月经量减少、子宫体积缩小、CA125值下降及脱环方面均明显优于对照组，差异均有统计学意义（P〈0．01）。不良反应观察组34例术后出现不同程度下腹坠痛，5例出现发热，体温37．5～38．8℃，予对症处理恢复正常；3例腺肌瘤直径达5cm者术后3个月复查超声仍可见3—4cm等回声区并突向宫腔方向，超声监视下行负压吸刮瘤腔，清理坏死组织。对照组21例（80．8％）半年内未闭经，阴道出血淋漓不尽。结论射频消融术联合LNG—IUS治疗子宫腺肌病优势互补，既减少了单独应用LNG—IUS近期出血的问题，又克服了单独射频消融术远期易复发的不足。

Radiofrequency Ablation Combined with Levonorgestrel-releasing Intrauterine System in Treatment of Adenomyosis

Objective To explore the clinical value of radiofrequency ablation combined with levonorgestrel-releasing intrauterine system(LNG-IUS) in treatment of adenomyosis.Methods 62 patients with adenomyosis admitted during April 2007 and April 2009 were divided into therapy group(36 cases) and control group(26 cases) randomly.The therapy group was treated with radiofrequency ablation combined with LNG-IUS,and the control group was treated with LNG-IUS.All patients were followed up to observe dysmenorrheal grading(VAS),amenorrhea,menstrual blood volume,uterine volume and carbohydrate antigen 125(CA125) at the 1st,3rd,6th and 12th month after treatment.Results The therapy group had obvious advantages over the control group in improving indicators such as dysmenorrheal,amenorrhea,reducing menstrual blood volume,uterine volume,lower rate of CA125 and decyclizing.The differences were statistically significant(P<0.01).Adverse reaction in therapy group was manifest in 34 patients with different degrees of coeliac bearing-down pain,5 patients ran a fever(body temperature 37.5-38.8℃) who returned to normal after relevant therapies,3 patients were found with endometrioma 5 cm in diam after operation on necrotic tissue 3 to 4 cm in diam protruding into the uterine cavity during sonographic examination 3 months later and underwent uterine aspiration.Endless abnormal vaginal bleeding occurred in 21 patients of the control group(80.8%) who could not achieve amenorrhea within 6 months.Conclusion Radiofrequency ablation combined with LNG-IUS in treatment of adenomyosis can play a complementary role.It can resolve the problem of irregular bleeding and constant relapses in using only LNG-IUS in a long term.