曼月乐治疗子宫腺肌病病灶阈值筛选的初步研究

目的 探讨曼月乐（左旋炔诺孕酮宫内缓释节育系统,LNG-IUS）治疗不同肌壁厚度子宫腺肌病的效果,寻找LNG-IUS治疗腺肌病有效的病灶阈值.方法 将84例子宫腺肌病病人按子宫肌壁厚度或腺肌瘤最大直径（maximum di-ameter,MD）分为A、B、C、D4组,4组病人均于经期宫内放置LNG-IUS,对比分析LNG-IUS放置前后不同时段病人经量、痛经评分、子宫体积和CA125的变化.结果 放置LNG-IUS后不同时段,A、B两组痛经、月经量评分、子宫体积、CA125均明显下降（P＜0.05）;C组痛经及经量评分缓解明显（P＜0.05）,但子宫体积、CA125下降不明显（P＞0.05）;D组痛经、经量评分、CA125和子宫体积均无明显变化（P＞0.05）.结论 LNG-IUS治疗子宫腺肌病存在病灶大小的选择性,其治疗有效的病灶阈值为MD≤35 mm.

A preliminary study of lesion threshold of adenomyosis for LNG-IUS treatment

Objective To observe the clinic effect of treating adenomyosis with different uterine wall thickness by LNG - IUS, in order to find the effective lesion threshold for LNG - IUS to treat adenomyosis. Methods 84 patients of adenomyosis were divided into four groups according to the maximum diameter （MD） of uterine wall as follows： group A（ MD≤25 mm, 15 cases）, group B（25 mm 〈 MD ≤30 mm, 25 cases）, group C （30 mm 〈 MD ≤35 mm, 20 cases）and group D （MD 〉 35 mm, 24 cases）. LNG- IUS were intrauterinely placed within menstrual period in all patients in four groups. The changes of menstrual quantity and dysmenorrhea, the uterine volumes and CA125 were analyzed before and after LNG - IUS treatment at different observation times. Results The changes of the menstrual quantity and dysmenorrhea, the uterine volumes and CA125 were significant in different observation times after LNG - IUS in group A and B （P 〈 0.05 ）. While in group C, the changes were only observed in scales of menstrual quantity and dysmenorrhea（ P 〈 O. 05 ）. Although the uterine volumes and CA125 dropped to some degrees, no significance was evident within the observation time in this research （P 〉 0. 05 ）. No obvious changes of the observation indexes mentioned above were found in group D （P 〉 0.05 ）. Conclusion There existed a kind of selectivity for lesion size when treating adenomyosis with LNG - IUS, and the threshold value of uterine wall of adenomyosis/adenomyoma for effective treatment appears to be the maximum diameter of uterine wall less than 35 mm.