GnRH-a联合曼月乐治疗巨大子宫腺肌病的临床分析研究

目的 探讨GnRH-a联合曼月乐(LNG-IUS)对大子宫腺肌病的治疗效果.方法 收集2014年7月至2015年9月因巨大子宫腺肌病于我中心行GnRH-a联合LNG-IUS治疗的患者50例,所有患者应用GnRH-a预处理3针后放环,放环时宫腔深度＞9cm.术后随访12个月,比较上环后不同时间的痛经缓解程度、月经量改变、子宫体积及不良反应.结果 ①放置LNG-IUS后痛经程度、月经量与放置前相比显著下降,并随放置时间延长呈进一步下降趋势;②子宫体积经GnRH-a预处理后显著缩小,放环后子宫体积出现反弹,但仍旧小于预处理前子宫体积,至放环后6～12个月子宫体积趋于平稳;③放置LNG-IUS后主要不良反应为阴道点滴出血及腹痛、腰酸.IUD脱落多发生于放环6个月内,与月经量多、子宫体积大有关.结论 GnRH-a联合曼月乐治疗宫腔深度＞9cm的子宫腺肌病具有较好的治疗效果,可显著缓解痛经、减少月经量,值得临床应用.

Clinical analysis of GnRH-a combined with LNG-IUS in the treatment of large adenomyosis

Objective To investigate the therapeutic effect of GnRH-a combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of adenomyosis.Methods From July 2014 to September 2015,fifty patients with large adenomyosis were recruited,whose depth of uterine cavity was larger than 9cm.All patients were inserted LNG-IUS following three courses of GnRH-a.All patients were followed up for 12 months.The scores of pain,menstrual blood volume,uterine volume and adverse reaction were compared to those before therapy.Results ①After placement of LNG-IUS,scores of pain and the menstrual blood volume had decreased significantly,and further decreasing over time.② The uterine volume decreased significantly after pretreated with GnRH-a,which rebounded after placement of LNG-IUS,but still smaller than the volume before pretreatment.The uterine volume tends to be stable after 6 to 12 months.③The main adverse reactions were vaginal bleeding,abdominal pain and backache after placing the LNG-IUS.Most of the IUD fall off happened in 6 months,which was associated with large volume of menstrual blood and the big volume of the uterine.Conclusion GnRH-a combined with LNG-IUS is effective in the treatment of adenomyosis when the uterine cavity depth ＞ 9 cm,which can significantly alleviate dysmenorrheaand reduce menstrual flow.