优思明及曼月乐对子宫内膜异位症的疗效比较
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摘要
目的探讨子宫内膜异位症患者保守手术后口服屈螺酮炔雌醇(优思明)及放置左炔诺孕酮宫内缓释系统(曼月乐)的临床疗效。方法选取2014年2月至2016年6月在江门市中心医院妇科腹腔镜保守手术的子宫内膜异位症的患者110例,随机分为优思明治疗组和曼月乐治疗组,6个月后观察两组患者在治疗前及治疗后痛经程度、月经量、子宫体积及检测CA125水平变化,并记录不良反应情况。结果两组患者治疗后与治疗前相比,VAS疼痛评分、月经量及CA125水平均较治疗前显著降低(曼月乐组:t值分别为4.39、6.69、6.87,均P<0.05;优思明组:t值分别为4.65、7.64、6.86,均P<0.05),而且采用曼月乐或优思明不同的治疗方法,对痛经缓解、月经改善、子宫体积缩小、CA125下降均表现出相似的效果,两组之间比率无显著性差异(χ2值分别为1.45、2.67、1.26、2.86,均P>0.05)。曼月乐组阴道异常流血发生率55.17%,较优思明组(16.67%)明显升高(χ2=7.87,P<0.05)。结论优思明及曼月乐对子宫内膜异位症的治疗均有一定疗效,可根据患者的具体情况选择性地选用治疗方案。
Objective To investigate the clinical effects of oral drospirenone-ethinylestradiol(Yasmin)and levonorgestrel-releasing intrautedrine system(Mirena)in patients with endometriosis after conservative surgery.Methods A total of 110 patients with endometriosis underwent conservative surgery of gynecologic laparoscopic surgery in Jiangmen Central Hospital from February2014 to June 2016,and they were randomly divided into Yasmin group and Mirena group.The levels of dysmenorrhea,menstrual blood volume,uterine volume and CA125 were measured before and six months after treatment.And the adverse reactions were recorded.Results VAS pain score,menstrual blood volume and CA125 level of two groups decreased significantly after treatment(t value was 4.39,6.69 and 6.87,respectively in Mirena group,t value was 4.65,7.64 and 6.86,respectively in Yasmin group,all P<0.05).The effect on relieving dysmenorrhea,improving menstruation,shrink of uterine volume and CA 125 decreasing was similar between two methods,and the differences between two groups were not significant(χ2 value was 1.45,2.67,1.26 and2.86,respectively,all P>0.05).The incidence of abnormal vaginal bleeding was 55.71%in Mirena group,which was remarkably higher than that(16.67%)in Yasmin group(χ2=7.87,P <0.05).Conclusion Yasmin and Mirenaon have certain effect on treatment of endometriosis,and treatment programs can be selected according to specific circumstances of patients.
Objective To investigate the clinical effects of oral drospirenone-ethinylestradiol(Yasmin)and levonorgestrel-releasing intrautedrine system(Mirena)in patients with endometriosis after conservative surgery.Methods A total of 110 patients with endometriosis underwent conservative surgery of gynecologic laparoscopic surgery in Jiangmen Central Hospital from February2014 to June 2016,and they were randomly divided into Yasmin group and Mirena group.The levels of dysmenorrhea,menstrual blood volume,uterine volume and CA125 were measured before and six months after treatment.And the adverse reactions were recorded.Results VAS pain score,menstrual blood volume and CA125 level of two groups decreased significantly after treatment(t value was 4.39,6.69 and 6.87,respectively in Mirena group,t value was 4.65,7.64 and 6.86,respectively in Yasmin group,all P<0.05).The effect on relieving dysmenorrhea,improving menstruation,shrink of uterine volume and CA 125 decreasing was similar between two methods,and the differences between two groups were not significant(χ2 value was 1.45,2.67,1.26 and2.86,respectively,all P>0.05).The incidence of abnormal vaginal bleeding was 55.71%in Mirena group,which was remarkably higher than that(16.67%)in Yasmin group(χ2=7.87,P <0.05).Conclusion Yasmin and Mirenaon have certain effect on treatment of endometriosis,and treatment programs can be selected according to specific circumstances of patients.
引文
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[8]王静依,何剑英,孟侠.左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察[J].中国妇产科临床杂志,2011,12(4):272-274.
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[11]田秦杰,王春庆.左炔诺孕酮宫内缓释系统在异常子宫出血中的应用进展[J].中华妇产科杂志,2014,49(7):553-556.
[2]Wu L X,Wu Q Y,Liu L.Oral contraceptive pills for endometriosis after conservative surgery:a systematic review and meta-analysis[J].Gynecol Endocrinol,2013,29(10):883-890.
[3]陈继明,吴洁,浦丹华,等.子宫内膜异位症术后GnRH-a治疗与黑升麻制剂的使用[J].中国妇幼健康研究,2014,25(2):344-347.
[4]康红.子宫内膜异位症术后连续或周期性服用屈螺酮炔雌醇片的疗效对比[J].中国妇幼健康研究,2015,26(4):785-787.
[5]Ji F,Yang X H,Ai Xing,et al.Role of levonorgestrelreleasing intrauterine system in dysmenorrhea due to adenomyosis and the influence on ovarian function[J].Clin Exp Obstet Gynecol,2014,41(6):677-680.
[6]Heikinheimo O,Gemzell-Danielsson K.Emerging indications for the levonorgestrel-releasing intrauterine system(LNG-IUS)[J].Acta Obstet Gynecol Scand,2012,91(1):3-9.
[7]Dhamangaonkar P C,Anuradha K,Saxena A.Levonorgestrel intrauterine system(Mirena):an emerging tool for conservative treatment of abnormal uterine bleeding[J].J Midlife Health,2015,6(1):26-30.
[8]王静依,何剑英,孟侠.左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察[J].中国妇产科临床杂志,2011,12(4):272-274.
[9]Ozdegirmenci O,Kayikcioglu F,Akgul M A,et al.Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis[J].Fertil Steril,2011,95(2):497-502.
[10]Ramazanzadeh F,Tavakolianfar T,Shariat M,et al.Levonorgestrel-releasing IUD versus copper IUD in control of dysmenorrhea,satisfaction and quality of life in women using IUD[J].Iran J Reprod Med,2012,10(1):41-46.
[11]田秦杰,王春庆.左炔诺孕酮宫内缓释系统在异常子宫出血中的应用进展[J].中华妇产科杂志,2014,49(7):553-556.