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目的:探讨左炔诺孕酮宫内释放系统(LNG-IUS;商品名:曼月乐)治疗子宫腺肌症所致中、重度痛经的临床疗效。方法:对子宫腺肌症所致中、重度痛经的患者37例,于月经期的第5～7天放置LNG-IUS,行自身前后对照。比较放置LNG-IUS前及放置后3、6、12个月时痛经评分,B超测量子宫大小,同时分别测定血清CA125、月经第3天血清雌二醇、卵泡刺激素(FSH)、黄体生成素(LH)水平。结果:放置LNG-IUS后12个月,37例痛经患者的VAS评分分别由置环前的(73±12)分后下降为置环后3、6、12月的(22±16)、(14±18)、(10±9)分,经量评分分别由置环前的(115.6±56.2)下降为置环后3、6、12月的(56.5±21.3)、(38.7±18.9)、(18.7±6.3),差异均有统计学意义(P<0.01)。置环前子宫内膜厚度、血清CA125分别由(8.0±1.8)和(37.8±14.6)下降为6、12月的(4.3±1.9)、(4.1±1.5)和(30.6±14.6)、(21.9±16.3),差异均有统计学意义(P<0.05)。29例(78.38%,29/37)患者对治疗的综合效果表示非常满意或满意。结论:LNG-IUS是手术之外治疗子宫腺肌症的有效且安全的方法。
Objective: To investigate the clinical efficacy of levonorgestrel-releasing intrauterine system (LNG-IUS; trade name: Mirena) in the treatment of moderate and severe dysmenorrhea caused by adenomyosis. Methods: Thirty-seven patients with moderate and severe dysmenorrhea caused by adenomyosis were enrolled. LNG-IUS was placed on the 5th to 7th days of the menstrual period, and their own front and back control were performed. Dysmenorrhea scores were measured before and 3, 6, and 12 months after LNG-IUS placement, and the uterine size was measured by B ultrasound. Serum CA125, serum estradiol, follicle-stimulating hormone (FSH) (LH) level. Results: At 12 months after LNG-IUS placement, VAS scores of 37 dysmenorrhea patients decreased from 73 ± 12 before ringing to 22 ± 16 at 3 and 6, (14 ± 18), (10 ± 9), respectively. The scores of meridians decreased from (115.6 ± 56.2) before setting ring to (56.5 ± 21.3), (38.7 ± 18.9) (18.7 ± 6.3), the difference was statistically significant (P <0.01). The thickness of the endometrium before ring setting decreased from (8.0 ± 1.8) and (37.8 ± 14.6) to (4.3 ± 1.9), (4.1 ± 1.5) and (30.6 ± 14.6) and (21.9 ± 16.3), the differences were statistically significant (P <0.05). Twenty-nine patients (78.38%, 29/37) were very satisfied or satisfied with the comprehensive effect of treatment. Conclusion: LNG-IUS is an effective and safe method of treating adenomyosis outside of surgery.