左炔诺孕酮宫内缓释系统与热球子宫内膜去除术治疗月经过多的疗效比较

目的评价左炔诺孕酮宫内缓释系统（LNG—IUS）与热球子宫内膜去除术（TBA）治疗月经过多的近期和远期疗效及安全性。方法将77例月经过多患者采用随机数字表法分为LNG—IUS组（39例）和TBA组（38例），治疗后随访36个月，观察两组患者的疗效、血红蛋白（Hb）、性激素水平、安全性及卫生经济学指标。结果①LNG—IUS组患者治疗前月经失血图（PBAC）评分和经期分别是（258．32±72．75）分和（10．90±2．37）d，治疗后3、6个月分别是（76．10±21．26）分、（9．52±1．61）d和（61．62±17．27）分、（8．32±1．33）d；TBA组治疗前分别是（254．89±67．18）分和（11．19±2．11）d，治疗后3、6个月分别是（58．94±44．09）分、（9．52±1．61）d和（52．83±31．56）分、（8．32±1.33）d，两组治疗前后比较，差异均有统计学意义（P〈0．05）；且LNG—IUS组治疗后12、24及36个月PBAC评分和经期少于TBA组（P〈0．05）。②LNG—IUS组和TBA组患者治疗后6个月Hb分别是（111．68±7．58）g／L和（114．22土6．22）g／L，均较治疗前[（87．90±6．42）g／L及（88．50±5．60）g／L）]明显升高（P〈0．05），但与治疗后12个月Hb[（116．16±4．29）g／L，（114．16±4．32）g／L）]比较，差异无统计学意义（P〉0．05）。③两组患者治疗前及治疗后6、12个月性激素水平无明显变化（P〉0．05）。④LNG—IUS组和TBA组治疗后6个月阴道不规则出血率分别为72．41％（21／29）和13．89％（5／36），两组比较，差异有统计学意义（P〈0．05）。两组阴道排液率分别为10．34％（3／29）和44．44％（16／36），两组比较，差异有统计学意义（P〈0．05）。两组均无大出血、宫腔积脓等并发症。结论LNG—IUS与TBA均可有效改善月经过多，纠正贫血，且安全、简单易行；TBA治疗月经过多的近期疗效较LNG—IUS确切，依从性更好。

Effect of levonorgestrel-- releasing intrauterine system and thermal balloon ablation for the treatment of heavy menstrual bleeding

Objective To compare the short - time and long - time effect of levonorgestrel - releasing intrau- terine system and thermal balloon ablation on the treatment of heavy menstrual bleeding. Methods 77 women with heavy menstrual bleeding were randomly assigned into LNG- IUS group （39 cases） and TBA group （38 cases）. The hemoglobin, sex hormone levels, safety and health economic benefit of the two groups were compared at 0, 3, 6, 12, 24, 36 months of treatment. Results ①The LNG- IUS and TBA menstrual quantity （use menstrual blood flow chart）, the menstrual period, menstrual cycle had improved obviously before and after treatment for 3 months, 6 months in the two groups （P〈0. 05）, and after 12 months treatment, menstrual quantity and menstru- al period in LNG - IUS group were significantly lower and shorter than that in TBA group （P〈0. 05） ; ② Compared with before treatment, hemoglobin was significantly elevated after treatment for 6 and 12 months （P〈0. 05）, but there was no difference between the two groups. ③ Sex hormone levels of group LNG- IUS had not changed greatly before and after treatment for 6 and 12 months （P〈0.05）. ④ Irregular vaginal bleeding of group LNG- IUS was more often than group TBA after treatment for 3 and 6 months （P〈0. 05）, but there was no difference between the two groups after treatment for 24 and 36 months （P〉0.05）. Conclusion Both LNG- IUS and TBA can effectively improve heavy menstrual bleeding, correct anemia, and are all safe, simple; the short- time effec- tive of TBA is exactly than LNG- IUS in treatment of menorrhagia, and compliance Both LNG- IUS and TBA are effective in improve heavy menstrual bleeding and correct anemia, they are all safe and simple to perform; the short- time effect and compliance of TBA is better than LNG- IUS.