左炔诺孕酮宫内缓释系统不同应用方法治疗子宫腺肌病疗效观察
详细信息    查看全文 | 推荐本文 |
  • 英文篇名:Effect of different application methods of levonorgestrel intrauterine sustained-release system in the treatment of adenomyosis
  • 作者:涂皎 ; 牟萌 ; 古衡芳 ; 梁志刚 ; 肖雁冰 ; 刘颂 ; 张振东 ; 何连利 ; 胡仕秀
  • 英文作者:TU Jiao;MOU Meng;GU Heng-fang;LIANG Zhi-gang;XIAO Yan-bing;LIU Song;ZHANG Zhen-dong;HE Lian-li;HU Shi-xiu;Department of Gynecology,the Maternal and Children Hospital Affiliated to Zunyi Medical University;Department of Gynecology,the Affiliated Hospital of Zunyi Medical University;Department of Gynecology,the First People' s Hospital of Zunyi City;Department of Gynecology,Maternal and Children Hospital of Bozhou district of Zunyi City;
  • 关键词:左炔诺孕酮宫内缓释系统 ; 子宫腺肌病 ; 促性腺激素释放激素抑制剂 ; 高强度聚集超声
  • 英文关键词:levonorgestrel intrauterine sustained-release system;;adenomyosis;;gonadotropin-releasing hormone inhibitors;;high intensity focused ultrasound
  • 中文刊名:XXYX
  • 英文刊名:Journal of Xinxiang Medical University
  • 机构:遵义医学院附属妇女儿童医院妇科;遵义医学院附属医院妇科;遵义市第一人民医院妇科;遵义市播州区妇幼保健院妇科;
  • 出版日期:2019-01-05
  • 出版单位:新乡医学院学报
  • 年:2019
  • 期:v.36;No.221
  • 基金:国家自然科学基金资助项目(编号:81460233);; 贵州省卫生计生委科学技术基金项目(编号:gzwjkj2015-1-071)
  • 语种:中文;
  • 页:XXYX201901007
  • 页数:5
  • CN:01
  • ISSN:41-1186/R
  • 分类号:38-42
摘要
目的探讨左炔诺孕酮宫内缓释系统(LNG-IUS)不同应用方法治疗子宫腺肌病的临床效果。方法采用随机抽样方法选择2014年12月至2017年12月在遵义医学院附属妇女儿童医院、遵义医学院附属医院、遵义市第一人民医院、遵义市播州区妇幼保健院进行诊治的300例子宫腺肌病患者为研究对象,根据腺肌瘤最大直径或子宫肌壁最大厚度将患者分为轻度组(腺肌瘤最大直径或肌壁最大厚度<30 mm)、中度组(腺肌瘤最大直径或肌壁最大厚度30~40 mm)和重度组(腺肌瘤最大直径或肌壁最大厚度> 40 mm),每组100例。轻度组患者于月经期第2~5天给予子宫内放置LNG-IUS;中度组患者于月经期第2~5天给予子宫内放置LNG-IUS,并每间隔28 d皮下注射亮丙瑞林3. 75 mg,共3次,或月经干净后给予高强度聚焦超声(HIFU)治疗;重度组患者于非经期给予肌壁大部切除-子宫重建术(MURU)治疗,并在术中给予子宫内放置LNG-IUS。比较3组患者治疗前及治疗后3个月的痛经程度、月经量评分、血清卵巢癌相关抗原(CA125)水平、子宫体积及治疗后3个月的不良反应。结果治疗前3组患者痛经程度、月经量评分、血清CA125水平比较差异均无统计学意义(F=0. 253、0. 562、0. 327,P> 0. 05),3组患者子宫体积比较差异有统计学意义(F=80. 042,P <0. 05)。治疗后3个月,3组患者痛经程度、月经量评分、血清CA125水平、子宫体积比较差异均无统计学意义(F=0. 242、0. 672、0. 672、0. 584,P> 0. 05)。3组患者治疗后3个月痛经程度、月经量评分、血清CA125水平及子宫体积均显著低于治疗前(P <0. 05)。治疗后3个月,轻度组、中度组、重度组患者不良反应发生率分别为16. 0%(16/100)、19. 0%(19/100)、18. 0%(18/100),3组患者不良反应发生率比较差异无统计学意义(χ~2=1. 488,P> 0. 05)。结论根据腺肌瘤最大直径或肌壁最大厚度选择LNG-IUS单独或联合促性腺激素释入激素抑制剂、HIFU、MURU治疗子宫腺肌病可以保留患者子宫并取得比较好的治疗效果。
        Objective To investigate the clinical effect of different application methods of levonorgestrel intrauterine sustained-release system( LNG-IUS) in the treatment of adenomyosis. Methods A total of 300 patients with adenomyosis in the Maternal and Children Hospital Affiliated to Zunyi Medical University,the Affiliated Hospital of Zunyi Medical University,the First People' s Hospital of Zunyi City and the Maternal and Children Hospital of Bozhou district of Zunyi City from December 2014 to December 2017 were selected as subjects. The patients were divided into mild group( the maximum thickness of myometrium or maximum thickness of uterine muscular wall < 30 mm),moderate group( the maximum thickness of myometrium or maximum thickness of uterine muscular wall was 30-40 mm) and severe group( the maximum thickness of myometrium or maximum thickness of uterine muscular wall > 40 mm) according to the maximum diameter of adenomyoma or maximum thickness of uterine muscular wall,100 cases in each group. The patients in the mild group were treated with LNGIUS intrauterine placement on the 2 ndto 3 rdday of menstruation. The patients in the moderate group were treated with LNG-IUS intrauterine placement on the 4 thto 10 thday of menstruation,and leuprorelin 3. 75 mg by subcutaneous injection every 28 days for three times,or high intensity focused ultrasound( HIFU) after menstruation. The patients in the severe group were treated with major uterine wall resection and reconstruction of the uterus( MURU) during non-menstrual period,and the LNG-IUS was placed in uterus during operation. The degree of dysmenorrhea,menstrual volume score,the level of serum carbohydrate antigen125( CA125) and uterine volume of patients in the three groups were observed before and three months after operation; and the adverse reaction was observed at three months after treatment. Results There was no significant difference in the degree of dysmenorrhea,menstrual volume score and the level of serum CA125 among the three groups before treatment( F = 0. 253,0. 562,0. 327; P > 0. 05). There was significant difference in uterine volume among the three groups( F = 80. 042,P < 0. 05).Three months after treatment,there was no significant difference in the degree of dysmenorrhea,menstrual volume score,serum CA125 level and uterine volume among the three groups( F = 0. 242,0. 672,0. 672,0. 584; P > 0. 05). The degree of dysmenorrhea,menstrual volume score,serum CA125 level and uterine volume of the patients at three months after treatment were significantly lower than those before treatment in the three group( P < 0. 05). Three months after treatment,the incidence of adverse reactions in the mild group,moderate group and severe group was 16. 0%( 16/100),19. 0%( 19/100) and 18. 0%( 18/100),respectively. There was no significant difference in the incidence of adverse reactions among the three groups( χ~2=1. 488,P > 0. 05). Conclusion LNG-IUS alone or in combination with gonadotropin-releasing hormone antagonist,HIFU and MURU in the treatment of adenomyosis can reserve the uterus according to the maximum diameter of adenomyoma,and achieve better therapeutic effect.
引文
[1] RADZINSKY V E,KHAMOSHINA M B,NOSENKO E N,et al.Treatment strategies for pelvic pain associated with adenomyosis[J]. Gynecol Endocrinol,2016,32(suppl 2):19-22.
    [2]古衡芳,梁志刚,涂皎,等.子宫腺肌病肌壁大部切除-子宫重建术对子宫血液动力学的影响[J].实用妇产科杂志,2016,32(3):193-196.
    [3]李雷,冷金花,贾双征,等.放置前预处理对于LNG-IUS治疗症状性腺肌病效果的影响[J].现代妇产科进展,2016,25(5):337-341.
    [4] SABBIONI L,PETRAGLIA F,LUISI S. Non-contraceptive benefits of intrauterine levonorgestrel administration:why not[J]. Gynecol Endocrinol,2017,33(11):822-829.
    [5] PARK D S,KIM M L,SONG T,et al. Clinical experiences of the levonorgestrel-releasing intrauterine system in patients with large symptomatic adenomyosis[J]. Taiwan J Obstet Gynecol,2015,54(4):412-415.
    [6]涂皎,高毅,黄茂兰,等.左炔诺孕酮宫内缓释系统对子宫腺肌症患者月经及卵巢功能的影响研究[J].中国全科医学,2016,19(4):427-430.
    [7] SENTURK L M,IMAMOGLU M. Adenomyosis:what is new[J].Womens Health(Lond),2015,11(5):717-724.
    [8] SHAABAN O M,ALI M K,SABRA A M,et al. Levonorgestrelreleasing intrauterine system versus a low-dose combined oral contraceptive for treatment of adenomyotic uteri:a randomized clinical trial[J]. Contraception,2015,92(4):301-307.
    [9]董秀凤,郭欣.促性腺激素释放激素激动剂联合放置左炔诺孕酮宫内缓释系统治疗子宫腺肌病的效果[J].广东医学,2017,38(13):2069-2071.
    [10] YUN B H,JEON Y E,SEO S K,et al. Effects of a levonorgestrelreleasing intrauterine system on the expression of steroid receptor coregulators in adenomyosis[J]. Reprod Sci,2015,22(12):1539-1548.
    [11]王瑞歌,王世进.促性腺激素释放激素激动剂联合高强度聚焦超声治疗子宫腺肌病疗效观察[J].新乡医学院学报,2017,34(6):529-531.
    [12]徐秋霞,赵相军.曼月乐联合散结镇痛胶囊对子宫腺肌病患者子宫体积、痛经及月经的影响[J].世界中医药,2018,13(8):1918-1920,1924.
    [13]方德容,赵菁,李青汉,等.曼月乐治疗子宫腺肌病病灶阈值筛选的初步研究[J].遵义医学院学报,2014,37(4):418-421.
    [14] BITZER J,HEIKINHEIMO O,NELSON A L,et al. Medical management of heavy menstrual bleeding:a comprehensive review of the literature[J]. Obstet Gynecol Surv,2015,70(2):115-130.
    [15]许静.腹腔镜切除术联合左炔诺孕酮宫内缓释系统对子宫腺肌症的治疗效果观察[J].国际医药卫生导报,2017,23(9):1360-1363.
    [16] ZHENG J,XIA E,LI T C,et al. Comparison of combined transcervical resection of the endometrium and levonorgestrelcontaining intrauterine system treatment versus levonorgestrelcontaining intrauterine system treatment alone in women with adenomyosis:a prospective clinical trial[J]. J Reprod Med,2013,58(7/8):285-290.
    [17]肖雁冰,赵菁,李青汉,等.“肌壁大部切除-子宫重建术治疗中、重度子宫腺肌病:术式与安全性探讨[J].遵义医学院学报,2012,35(4):302-305.
    [18]赵菁,李青汉,方德容,等.肌壁大部切除-子宫重建术联合曼月乐治疗中、重度子宫腺肌病的疗效[J].中国妇幼保健,2013,28(15):2464-2466.
    [19]李旭卿,陶丽娜,任洪叶.孕三烯酮与左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床疗效及安全性分析[J].医学临床研究,2017,34(1):46-48.
    [20]肖雁冰.子宫腺肌病治疗现状与展望[J].遵义医学院学报,2015,38(3):215-218.
    [21] YOUM J,LEE H J,KIM S K,et al. Factors affecting the spontaneous expulsion of the levonorgestrel-releasing intrauterine system[J]. Int J Gynaecol Obstet,2014,126(2):165-169.
    [22] KIM M L,SEONG S J. Clinical applications of levonorgestrelreleasing intrauterine system to gynecologic diseases[J]. Obstet Gynecol Sci,2013,56(2):67-75.
    [23] CHO S,NAM A,KIM H,et al. Clinical effects of the levonorgestrelreleasing intrauterine device in patients with adenomyosis[J]. Am J Obstet Gynecol,2008,198(4):373,e1-e7.
    [24]涂灵,曹华斌,邬欢欢. LNG-IUS与GnRHa方案治疗子宫腺肌病效果比较[J].山东医药,2012,52(30):7-9.
    [25]甄小红.小剂量米非司酮、LNG-IUS系统及GnRHa对子宫腺肌症的治疗观察[J].中国实用医刊,2012,39(14):18-21.
    [26] SHENG J,ZHANG W Y,ZHANG J P,et al. The LNG-IUS study on adenomyosis:a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis[J].Contraception,2009,79(3):189-193.
    [27]赵骏达,肖金宝,李燕,等. GnRH-a联合LNG-IUS治疗大子宫腺肌病和子宫肌瘤的疗效观察[J].中国性科学,2016,25(9):34-37.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700