GnRHa联合左炔诺孕酮宫内缓释系统治疗大子宫腺肌病的疗效观察

摘要

目的：探讨促性腺激素释放激素激动剂（GnRHa）联合左炔诺孕酮宫内缓释系统（LNG-IUS，商品名曼月乐）治疗大子宫腺肌病的临床疗效。方法：将42例妇科检查子宫体积≥孕3个月或宫腔深度＞11 cm的子宫腺肌病患者随机分为2组，每组21例。对照组给予注射GnRHa 4个周期；研究组注射GnRHa 4个周期后，给予放置LNG-IUS。分别记录两组注射GnRHa前（T0），GnRHa治疗结束（T1），GnRHa治疗后3个月（T3）、GnRHa治疗后6个月（T6）、GnRHa治疗后9个月（T9）、GnRHa治疗后12个月（T12）子宫体积、痛经评分及月经量评分。结果：GnRHa治疗后3，6，9和12个月，研究组的子宫体积、痛经评分及月经量评分均明显小于对照组（P＜0.05）；对照组GnRHa治疗结束时及治疗后3个月的子宫体积、痛经评分及月经量评分均明显小于治疗前的水平（P＜0.05），但治疗后6，9和12个月的子宫体积、痛经评分及月经量评分与治疗前比较差异无统计学意义（P＞0.05）；研究组GnRHa治疗结束时（即放置LNG-IUS时）及治疗后3，6，9和12个月的子宫体积、痛经评分及月经量评分均明显小于治疗前水平（P＜0.05）。结论：与单纯注射GnRHa相比，GnRHa联合LNG-IUS能更有效治疗大子宫腺肌病，短期内延长治疗效果，缓解临床症状。%Objective: To explore the curative effect of GnRHa combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of severe large uterine adenomyosis. Methods:A total of 42 cases of severe uterine adenomyosis were divided into two groups randomly, the treatment group and the control group, with 21 cases in each group. The treatment group were inserted LNG-IUS following 4 cycles of treatment by GnRHa and the control group were treated only by 4 cycles of GnRHa. Six months after placement of LNG-IUS, uterine size, menstrual quantity and degree of dysmenorrhea were compared between the two groups. Follow-up was taken at the following time points: before the injection of GnRHa (T0), immediately after the injection of GnRHa (T1), 3 months (T3), 6 months (T6), 9 months (T9), 12 months (T12) after the injection of GnRHa. Also the size of uterus, menstrual quantity and degree of dysmenorrhea were recorded during the follow-up. Results:The size of uterus, menstrual quantity and degree of dysmenorrheal in the treatment group at T3, T6, T9, T12 were significantly decreased than that in the control group (P<0.05). Compared with that at T0, the size of uterus at T1, menstrual quantity and degree of dysmenorrheal in the control group at T3 were significantly decreased (P<0.05). But there was no significantly difference in the size of uterus, menstrual quantity and degree of dysmenorrheal between the control group at T6, T9 and T12 and the control group at T0. The size of uterus at T1, menstrual quantity and degree of dysmenorrheal in the treatment group at T3, T6, T9, T12 were significantly decreased than that at T0 (P<0.05). Conclusions:Compared with the sole injection of CnRHa, GnRHa combined with LNG-IUS is more effective for a short term in the treatment of severe uterine adenomyosis and relief of clinical symptoms.