GnRH-a联合LNG-IUS治疗子宫腺肌症的疗效、月经模式与副反应

摘要

目的：探讨促性腺激素释放激素激动剂（Gonadotropin-releasing hormone analogue-A，GnRH-a）联合左炔诺孕酮宫内释放系统（levonorgestrel intrauterinesystem，LNG-IUS；曼月乐环）治疗子宫腺肌症（Adenomyosis，AM）的疗效。方法对2009年1月～2011年6月在我院就诊的25例AM患者给予GnRHa联合LNG-IUS治疗；所有患者用戈舍瑞林3.6 mg皮下注射，6个月后放置LNG-IUS，并继续随访30个月。于治疗前（B）、6针GnRHa后的第28天，即放置LNG-IUS前（G6），LNG-IUS后第1个月（L1）、3个月（L3）、6个月（L6）、9个月（L9）、12个月（L12）、18个月（L18）、24个月（L24）、30个月（L30）观察其疗效（子宫体积、内膜厚度、痛经VAS评分、血红蛋白变化）、月经模式及副反应。结果在GnRHa6个月及联合曼月乐环12个月内子宫体积较治疗前明显缩小，此后随访至30个月，子宫体积逐渐增大，但与治疗前比较，差异无统计学意义（P＞0.05）；在联合治疗36个月的随访期内，与治疗前相比，内膜厚度明显变薄、痛经症状明显缓解，血红蛋白明显升高；其月经模式表现为不规则阴道出血改善、月经趋向规则、经量减少并走向月经稀发与闭经。其主要的副反应表现为环脱落（4%）、卵巢囊肿、体重增加、痤疮、乳房胀痛等。结论本研究提示GnRHa联合LNG-IUS治疗AM可明显的缓解痛经，改善月经过多，对控制子宫体积也有一定作用，副反应较轻，尤其适用于要求保留子宫的较大型子宫腺肌症患者。%ObjectiveTo evaluate the clinical outcomes of gonadotropin-releasing hormone analog (GnRHa) combined with implantation of a levonorgestrel-releasing intrauterine system(LNG-IUS) in adenomyosis patients with signiifcantly enlarged uteruses.MethodsTwenty-ifve adenomyosis patients from January 2009 to June 2011 at Fudan University Obstetrics and Gynecology hospital were recruited for the study .Before treatment (B), the ifrst 28 days after injected of GnRHa at the sixth cycles , before the LNG-IUS was placed(G6), , the ifrst LNG-IUS after a month (L1), 3 months (L3), 6 months (L6 ) , 9 months (L9), 12 months (L12), 18 months (L18), 24 months (L24), 30 months (L30) to observe its effect ( uterine volume , endometrial thickness ,dysmenorrhea VAS score hemoglobin changes ) , menstrual pattern and side effects.Resultsthe six months of GnRHa and within 12 months of LNG-IUS uterine volume was signiifcantly reduced compared with before treatment , then followed up to 30 months, uterine volume increases , but no statistically signiifcant before treatment; In combination therapy 36 month follow-up period, compared with before treatment, endometrial thickness was significantly thinner , dysmenorrhea symptoms were relieved , hemoglobin was signiifcantly increased, and there is a signiifcant difference .Menstrual pattern characterized by irregular vaginal bleeding to improved, menstrual tends to be regular, Menstrual quantity decreases and tends to be oligomenorrhea or amenorrhea,The main side effects showed an expulsion of LNG-IUS (4%), ovarian cysts , weight gain , acne, and breast tenderness.ConclusionThis study suggests that GnRHa combined with LNG-IUS therapy can signiifcantly relieve dysmenorrhea, improve menorrhagia, have an important role in controlling inuterine volume, few side effects , especially for applications that require retention the uterus of adenomyosis patients.