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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>9 cm。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>9 cm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。
Objective To investigate the therapeutic effect of GnRH-a combined with Mirena (LNG-IUS) on large adenomyosis. Methods Fifty patients with GnRH-a combined with LNG-IUS treated with giant adenomyosis were enrolled from July 2014 to September 2015. All patients were treated with GnRH-a pretreatment 3 needles. Uterine cavity depth> 9 cm. The patients were followed up for 12 months. The degree of dysmenorrhea, menstrual volume changes, uterine volume and adverse reactions were compared at different times after the operation. Results (1) Dysmenorrhea after LNG-IUS placement was significantly lower than that before placement and further decreased with prolongation of storage time. (2) Uterine volume decreased significantly after GnRH-a pretreatment Uterine volume rebound, but still less than pre-treatment uterine volume, to 6 to 12 months after release of the uterus volume tends to be stable; (3) LNG-IUS after the main adverse reactions were vaginal bleeding and abdominal pain, backache. IUD shedding occurred more than 6 months in the ring, and menstrual flow, uterine volume related. Conclusions GnRH-a combined with Mirena music treatment of uterine adenomyosis uterine cavity depth> 9 cm has a good therapeutic effect, can significantly ease the dysmenorrhea, reduce menstrual flow, worthy of clinical application.