宫腔镜子宫内膜切除联合左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

目的:观察宫腔镜子宫内膜切除(TCRE)联合左炔诺孕酮宫内缓释系统(曼月乐)治疗子宫腺肌病患者的疗效。方法:选择无生育要求且欲保留子宫的腺肌病患者43例,研究组20例,先行宫腔镜子宫内膜切除术之后再放置曼月乐;对照组23例单纯放置曼月乐。治疗后定期随访了解患者月经状况,以VAS视觉评分评估其痛经状况,并进行阴道超声及妇科检查。结果:两组治疗前后在控制月经过多及痛经方面均效果显著。组间比较显示,治疗后3个月、半年及1年的阴道不规则出血率及闭经率比较有统计学差异(P<0.001),但两组间疼痛缓解状况比较无统计学差异(P=0.061)。结论:宫腔镜子宫内膜切除联合左炔诺孕酮宫内缓释系统治疗子宫腺肌病可以有效防止单纯放置曼月乐所引起的淋漓出血,同时可以防止TCRE术后各种并发症的发生。

Clinical observation on hysteroscopic transcervical resection of endometrium combined with levonorgestrel-releasing intrauterine system in treatment of adenomyosis

Objective: To observe the curative effect of hysteroscopic transcervical resection of endometrium(TCRE) combined with levonorgestrel-releasing intrauterine system(ING-IUS)(Mirena) in treatment of adenomyosis. Methods: Forty-three patients with adenomyosis who had no birth demand and wanted to reserve uterus were selected,then they were divided into two groups.Twenty patients in study group were treated with hysteroscopic TCRE,then Mirena was applied;twenty-three patients in control group were treated with Mirena.After treatment,the menstrual situations of the patients were followed up regularly,VAS was used to evaluate dysmenorrhea,transvaginal ultrasonography and gynecological examination were carried out. Results: In the two groups,the curative effects of controlling menorrhea and dysmenorrhea were dominant after treatment.There was statistically significant difference in the incidences of irregular vaginal bleeding and amenorrhea at three months,six months,and one year after treatment between the two groups(P<0.001),bu there was no statistically significant difference in pain relief between the two groups(P=0.061). Conclusion: Hysteroscopic TCRE combined with LNG-IUS for treatment of adenomyosis can prevent dripping bleeding induced by application of Mirena effectively and prevent the occurrence of various complications after TCRE at the same time.