子宫腺肌病两种保守治疗方法近期疗效比较

目的:观察宫腔内放置左炔诺孕酮宫内缓释系统(LNG-IUS)与选择性双侧子宫动脉栓塞术治疗子宫腺肌病的近期临床效果,探讨保守治疗子宫腺肌病的最佳方案。方法:比较放置LNG-IUS(30例,A组)或行子宫动脉栓塞术(18例,B组)治疗子宫腺肌病患者术后1、6、12个月的痛经改善情况、月经满意度和子宫体积变化。结果:术后1个月A组痛经缓解程度优于B组(P0.001),术后6个月和12个月两组痛经缓解程度无统计学差异(P=0.222和P=0.226)。两组患者术后月经量均减少,随着时间延长,A组患者逐渐出现闭经或淋漓出血,B组患者月经正常,月经满意度较A组高(P0.05)。两组术后子宫体积均较术前明显缩小(P0.001),B组子宫体积缩小较A组更明显(P0.001)。B组有2例术后意外妊娠而行人工流产术。B组治疗费用较A组高(P0.05)。结论:放置LNG-IUS治疗子宫腺肌病较介入治疗方法简单、痛苦小、费用低,但有子宫淋漓出血和闭经的副作用。无生育要求且能耐受闭经者,可选择放置LNG-IUS治疗,效果不理想再行双侧子宫动脉栓塞术治疗。

Two kinds of conservative treatment of adenomyosis

Objective： To assess the short-term outcomes of levonorgestrel intrauterine system （LNG-IUS） and uterine artery embolisation （UAE） in the treatment of adenomyosis. Methods： A retrospective study was conducted in 30 patients with LNG-IUS insertion （group A） and 18 patients with UAE treatment （group B）. The indicators for evalua tion included the degree of dysmenorrheal relief, the satisfaction rate concerning menstruation and volume changes of the uterine, which were evaluated 1, 6, and 12 months after the operation. Results： The degree of dysmenorrheal relief of group A was higher than that of group B （P〈0.001）. There were no significant differences in the degree of dysmenorrheal relief 6 and 12 months after the operation between the two groups （P = 0.222 and P = 0.226）. Menstrual bleeding both decreased in two groups. As time went on, women in group A experienced amenorrhea and spotting, while those in group B had no change of menstrual bleeding. The satisfaction rate concerning menstruation of group B was higher than that of group A （P 〈0.05）. The uterine volume decreased significantly after intervention in both groups （P〈0.001）, and the reduction was more significant in group B （P〈0.001）. Two patients were treated with induced abortion due to unexpected pregnancy in group B. Hiher cost of treatment was found in group B. Conclusion： LNG-IUS insertion was a simple, less pain and cheap intervention. However, it has a higher rate of abnormal vaginal bleeding and amenorrhea. For patients who have no desire of pregnancy, LNG-IUS insertion is the preferred conservative strategy. And UAE treatment is chosen when LNG-IUS insertion has no effect.