GnRH-a联合LNG-IUS治疗38例大子宫腺肌病的临床观察

目的:探讨联合应用促性腺激素释放激素激动剂(GnRH-a)与放置左炔诺孕酮宫内缓释系统(LNG-IUS)治疗大子宫腺肌病的临床效果。方法:38例大子宫腺肌病患者(测宫腔长度≥10 cm)接受皮下注射达菲林3.75 mg,每4周1次,至测量宫腔深度≤9 cm时由专人放置LNG-IUS。在用GnRH-a治疗前、放置LNG-IUS后6、12、18、24个月进行痛经VAS评分和月经量PBAC评分,并检测子宫体积和血红蛋白变化情况。结果:放置LNG-IUS后6、12、18、24个月痛经评分、月经量评分与GnRH-a治疗前比较明显降低,差异有统计学意义(P<0.05);并且放置LNG-IUS后12、18、24个月痛经评分、月经量评分与放置后6个月比较差异也有统计学意义(P<0.05),而放置LNG-IUS后12、18、24个月痛经评分、月经量评分比较差异无统计学意义(P>0.05)。子宫体积在放置LNG-IUS时与GnRH-a治疗前比较显著变小(P<0.05)。放置LNG-IUS后6和12个月较放置LNG-IUS时增大(P<0.05),但仍较GnRH-a注射治疗前小(P<0.05);且放置LNG-IUS后18、24个月子宫体积逐渐缩小,与GnRH-a注射治疗前及放置LNG-IUS后6、12月比较差异有统计学意义(P<0.05),而与放置LNG-IUS时比较差异无统计学意义(P>0.05)。血红蛋白在GnRH-a联合LNG-IUS治疗后升高至正常,与GnRH-a治疗前相比差异有统计学意义(P<0.05),而放置LNG-IUS后6、12、18、24个月之间血红蛋白比较差异无统计学意义(P>0.05)。结论:注射GnRH-a后联合放置LNG-IUS对大子宫腺肌病合并的痛经与月经过多有显著的治疗效果。

Clinical study of the treatment of levonorgestrel-releasing intrauterine system combined with GnRH analogue in 38 cases with large adenomyosis

Objective:To study the effects of levonorgestrel-releasing intrauterine system(LNG-IUS) combined with GnRH analogue(GnRH-a) in the treatment of adenomyosis with uterine body enlargement. Methods:A total of 38 cases(measured uterine length≥10 cm,average age 36.7 years) with adenomyosis received injections of GnRH-a(Da Feilin) every 4 weeks,and after the uterine cavity depth was reduced to below 9 cm,LNG-IUS was deployed.VAS pain score,PBAC bleeding score,uterine volume,and hemoglobin levels of the women were measured before the treatment and at 6,12,18 and 24 months after LNG-IUS placement. Results:The VAS pain score and PBAC bleeding score were significantly lowered at 6,12,18 and 24 months after LNG-IUS placement(P<0.05),and the score at 12,18 and 24 month were significantly lower than that at 6 month.The uterine volume decreased significantly at the time of LNG-IUS placement,6 and 12 month after LNG-IUS placement as compared with that before the treatment of GnRH-a,but was significantly greater at 6 and 12 month than that at the time of LNG-IUS placement(P<0.05).And the uterine volume decreased significantly at 18 and 24 month in comparison with that at 6 and 12 month after LNG-IUS placement and before the treatment of GnRH-a,but was not statistically significant in comparison with that at the time of LNG-IUS placement.Serum hemoglobin levels was increased gradually to normal after combined treatment(P<0.05).The difference of the VAS pain score,PBAC bleeding score serum and the hemoglobin levels were not significant from each other(6,12,18,24 months after LNG-IUS placement,P>0.05). Conclusion:The therapeutic alliance of LNG-IUS placement after GnRH analogue injection can be effective for the large adenomyosis with dysmenorrhea and hypermenorrhea.