目的:观察对子宫腺肌病采用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗方法的临床效果.方法:将63例子宫腺肌病患者根据治疗方法分为两组,研究组(n=33)采用腹腔镜子宫楔形切除术合并术后阴道置放左炔诺孕酮宫内缓释系统治疗,对照组(n=30)仅采用腹腔镜子宫楔形切除术治疗;观察比较两组患者术后3、6、12、24个月的子宫体积、月经量、痛经评分、血红蛋白、血清CA125水平及术后随访期间的复发和妊娠情况.结果:研究组患者术后12个月及24个月时的子宫体积小于对照组(P＜0.05),术后12月及24月时的疼痛评分显著低于对照组(P＜0.01),术后24个月时的月经量少于对照组(P＜0.01);研究组患者术后24月内的血清CA125及血红蛋白水平控制较好,而对照组术后血清CA125水平逐渐升高,而血红蛋白水平逐渐降低,但两组数据间比较差异无统计学意义(P＞0.05);研究组中术后24个月内0例复发,而对照组出现3例复发(P＞0.05);对照组2例患者顺利妊娠,研究组中无患者成功妊娠.结论:采用腹腔镜子宫楔形切除术并术后阴道置放左炔诺孕酮宫内缓释系统治疗子宫腺肌病可更有效地缓解患者的症状,控制疾病的进展,故具有较好的疗效.%Objective:To observe the effect of postoperative use of levonorgestrel slow releasing system in the vagina on adenomyosis patients after laparoscopic uterus wedge resection.Methods:63 patients with uterine adenomyosis were divided into two groups according to different treatment.The research group(n =33) was given the laparoscopic uterus wedge resection combined with postoperative use of levonorgestrel slow releasing system in the vagina,while the control group(n =30) was only given laparoscopic wedge resection of the uterus.The uterine volume,menstrual quantity,dysmenorrhea scores,hemoglobin,serum CA125 level of two groups at postoperative 3,6,12,24 months and postoperative recurrence and pregnancy rate were compared.Results:The uterine volume of the research group at 12 months and 24 months postoperatively was less than that of the control group(P ＜ 0.05).The pain score of the research group at 12 months and 24 months postoperatively was significantly less than that of control group(P ＜0.01).The menstrual quantity of the research group at 24 months was obviously less than that of the control group(P ＜ 0.01).The serum CA125 and hemoglobin level of the research group after operation were stable,while the serum CA125 level of the control group increased and the hemoglobin gradually decreased,without statistically significant difference(P ＞ 0.05).The recurrence of the research group and control group after operation was 0 and 3 cases respectively(P ＞ 0.05).The control group had 2 cases of successful pregnancy,and the research group had none.Conclusions:The postoperative use of levonorgestrel slow releasing system in the vagina on adenomyosis patients with laparoscopic uterus wedge resection can more effectively relieve symptoms,control the progress of the disease,hereby exerting a better clinical effect.
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