上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

子宫内膜电切术联合左炔诺孕酮宫内节育系统治疗子宫腺肌病的前瞻性研究

陈富强，张爱凤，王小波   

  1. 上海市浦东新区妇幼保健院妇产科，上海 201206
  • 出版日期:2017-05-28 发布日期:2017-05-31
  • 作者简介:陈富强（1963—），男，副主任医师，硕士；电子信箱：cfq19631010@163.com。
  • 基金资助:

    上海市卫生局科研项目（20114140）

Prospective study of the treatment of adenomyosis by combining hysteroscopic transcervical resection of endometrium with levonorgestrel-releasing intrauterine system

CHEN Fu-qiang, ZHANG Ai-feng, WANG Xiao-bo   

  1. Department of Obstetrics and Gynecology, Pudong New Area Women & Children Hospital, Shanghai 201206, China
  • Online:2017-05-28 Published:2017-05-31
  • Supported by:

    Research Project of Shanghai Municipal Health Bureau, 20114140

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摘要：

目的 ·探讨宫腔镜子宫内膜切除术（TCRE）联合左炔诺孕酮宫内节育系统（曼月乐）治疗子宫腺肌病的临床价值。方法 · 112例子宫肌腺病患者按1:1随机分为联合组和曼月乐组。联合组采用宫腔镜下TCRE，术后宫内放置曼月乐治疗；曼月乐组单纯放置曼月乐治疗。术后随访36个月，观察月经量、血红蛋白水平、痛经评分、子宫体积、血CA125水平及并发症。结果 ·患者平均随访时间42个月，3年随访通过率联合组为73.21%，曼月乐组为50.00%。术后3～36个月2组患者月经量明显减少或缺乏，血红蛋白水平明显提高，血CA125水平及痛经评分明显降低，术后6～12个月子宫体积明显缩小，与术前比较差异均有统计学意义。术后24个月联合组子宫体积缩小程度明显优于曼月乐组[(171.3±34.8) mm3 vs (213.7±38.6) mm3]。曼月乐组子宫切除率、环脱落率、突破性出血发生率、36个月不规则少量阴道出血发生率均高于联合组（12.50% vs 5.36%，16.07% vs 5.36%，8.93% vs 3.57%，62.25% vs 12.50%)，2组比较差异均有统计学意义（P<0.05）。2组常见不良反应比较，差异无统计学意义。结论 · TCRE联合曼月乐治疗子宫腺肌病临床疗效显著，能显著减少因单纯放置曼月乐引起的不规则少量阴道流血，是保守治疗子宫腺肌病的有效方式。

关键词: 子宫腺肌病, 曼月乐, 宫腔镜, 子宫内膜去除术

Abstract:

Objective · To explore the clinical application value of hysteroscopic transcervical resection of endometrium (TCRE) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods · A total of 112 cases of adenomyosis patients were divided randomly into the combination group and Mirena group. The combination group (56 cases) was treated by TCRE endometrium endometrial resection, assisted Mirena treatment after operation. Mirena group (56 cases) was treated by Mirena only. The follow-up lasted 36 months after treatment, including measures of the volumes of menstrual bleeding, hemoglobin levels, dysmenorrhea scores, uterine volume, serum CA125 levels and incidences of complications. Results · The median follow-up duration was 42 months, and the three-year follow-up rate was 73.21% for the combination group and 50% for the Mirena group. After surgery, the volumes of menstrual bleeding of patients in 3-36 months decreased significantly, with an increase in hemoglobin level and a decrease in serum CA215 level and dysmenorrhea scores. Compared with their situations before surgery, the difference was significant (P<0.05). A comparison of uterine volume before and after surgery showed that there is a significant decrease in the uterine volume in both groups in 6-12 months after surgery (P<0.05). Twenty-four months after surgery, it shows that the combination group has a much more significant decrease in uterine volume [(171.3±34.8) mm3] than Mirena group [(213.7±38.6) mm3] (P<0.05). The hysterectomy rate in Mirena group was significantly higher than that in the combination group (12.50% vs 5.36%); the ring expulsion rate was 16.07% in Mirena group and 5.36% in the combination group, and the break through bleeding happening rate was 8.93% in Mirena group and 3.57% in the combination group. After 36 months an irregular small amount of vaginal bleeding rate was 62.25% in Mirena group, while it was only 12.50% in the combination group. There was significant difference when comparing above indices between two groups (P<0.05). There was no obvious differences in most common side effects of both groups. Conclusion · Hysteroscopic TCRE combined with Mirena reduces significantly the irregular menstrual bleeding caused by merely applying Mirena. It has a prominent clinical efficacy and can be an effective approach in treatment of adenomyosis.

Key words: adenomyosis, levonorgestrel-releasing intrauterine system, hysteroscopy, transcervical resection of endometirum