左炔诺孕酮宫内缓释系统治疗阴道直肠隔子宫内膜异位症的临床观察

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS)治疗阴道直肠隔子宫内膜异位症(RVEM)疼痛的有效性。方法:回顾分析2006年1月至2009年4月就诊于北京协和医院19例有中、重度痛经的RVEM患者应用LNG-IUS的治疗效果,所有RVEM患者的诊断均经活检病理证实。应用LNG-IUS后随访6个月、1年、2年、3年,妇科查体结节大小、CA125、各种疼痛症状、月经情况以及副作用。结果:放置LNG-IUS后3年后,痛经评分由原来的8.42±1.34下降为2.36±2.73(P=0.003)。血清CA125从放置6个月时开始显著下降(P0.0001)。6个月时痛经、性交痛缓解率可达100%,经期大便痛缓解率89.47%。36个月时3者缓解率分别为84.62%、76.92%、69.23%。放置LNG-IUS后复发率较术后期待治疗明显下降,1年复发率为0,2年复发率6.7%(1/15),3年复发率23.1%(3/13)。放置LNG-IUS后1年内经期延长和不规则出血是常见现象,随着放置时间延长,情况有所缓解。结论:深部侵润型子宫内膜异位症不愿手术者,应用LNG-IUS在短期内可有效地缓解疼痛,但随着放置时间的延长,疼痛的复发几率增加。

The clinical observation of levonorgestrel intrauterine system treatment of recto-vaginal endometriosis

Objective:To evaluate the effectiveness of levonorgestrel intrauterine system as therapy for recto-vaginal endometriosis.Methods:From Jan.2006 to April 2009 in Peking Union Medical College Hospital,19 women who had moderate or severe pain associated with recto-vaginal endometriosis on first menstruation after lesion biopsy were inserted into LNG-IUS.Prospective analysis of the 19 patients with LNG-IUS placed cases was conducted.During 6 months,1 year,2 year,3 years' follow-up,observation of uterine size,CA125,pain,menstrual conditions,recurrence rate and continuation rate was performed.Results:The VAS of dysmenorrhea dropped continuously and significantly from the baseline score of 8.42±1.34 to 2.36±2.73 after 36 months of the LNG-IUS insertion(P=0.003).The serum CA125 levels reduced significantly starting from 6 months after device insertion(P<0.0001).At 6 months,the remission rates of dysmenorrhea and dyspareunia were 100% respectively,and the remission rate of defecation pain was 89.47%.At 36 months,the remission rates of the symptoms above were 84.62%,76.92%,69.23% respectively.1-year recurrence rate was 0,2 year was 6.7%(1/15),3 year was 23.1%(3/13).Within 1 year after LNG-IUS placed,menostaxis or irregular bleeding was a common phenomenon;with the extension of intrauterine time,the irregular bleeding and menostaxis had somewhat alleviated.Conclusions:The patients with deep infiltrating endometriosis lesions who rejected the operations could insert the LNG-IUS to ease the pain,extend the recurrence time and reduce the relapse rate.