左炔诺孕酮宫内节育系统治疗子宫腺肌病患者的疗效和不良反应观察

目的: 探讨左炔诺孕酮宫内节育系统（曼月乐）治疗子宫腺肌病的疗效和不良反应。方法: 回顾性分析2013年9至12月于浙江大学医学院附属妇产科医院因子宫腺肌病就诊并放置曼月乐的患者75例，共随访39个月，观察曼月乐的疗效和不良反应。结果: 月经量增多和月经量正常的患者放置曼月乐后月经量评分均降低（118±13和29±33，82±15和14±13，均P < 0.01），月经量增多者比月经量正常者的月经量评分降低更明显（90±35和69±19，P < 0.01）。放置曼月乐后患者痛经评分降低7（6，7）和1（0，2），P < 0.01]。患者发生曼月乐脱落18例（24.0%），放置曼月乐无效9例（12.0%），发生月经模式改变28例（37.3%）。多因素Cox回归分析未发现治疗后痛经评分、治疗前后月经量评分和月经稳定时间与曼月乐环脱落相关（均P>0.05）。结论: 曼月乐在子宫腺肌病的长期保守治疗中总体安全有效，约1/3的患者可能因曼月乐脱落或治疗无效接受进一步治疗。

Efficacy and adverse effects of levonorgestrel-releasing intrauterine system in treatment of adenomyosis

Objective: To evaluate the efficacy and adverse effects of levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods: The clinical data of 75 patients with adenomyosis who had Mirena insertion in Women's Hospital, Zhejiang University School of Medicine from September 2013 to December 2013 were retrospectively analyzed. The patients were followed up to 39 months. The efficacy and adverse effects were assessed. Results: Pictorial Blood Loss Assessment Chart (PBAC) scores were decreased significantly after Mirena insertion both in patients with menorrhea (118±13 vs. 29±33, P < 0.01) and normal menstruation (82±15 vs. 14±13, P < 0.01); the patients with menorrhea showed a more significant decrease in PBAC score than those with normal menstruation (90±35 vs. 69±19, P < 0.01). The visual analogue scale (VAS) score decreased significantly after Mirena insertion compared with pre-treatment7(6, 7) vs. 1(0, 2), P < 0.01]. The expulsion of Mirena occurred in 18 cases (24.0%); 9 cases (12.0%) had no effect and 28 cases (37.3%) had changes of menstruation patterns. Multivariate Cox regression analysis showed that the expulsion of Mirena was not associated with post-treatment VAS score, PBAC score before and after treatment or menstrual stabilization time (all P>0.05). Conclusion: Mirena is effective and safe in the long term management of adenomyosis, but about one third patients may require further treatment because of the expulsion or ineffectiveness of Mirena.