治疗性左炔诺孕酮宫内缓释系统对经量过多和痛经的疗效观察

发布时间：2018-02-24 02:06

本文关键词： LNG-IUS GnRHa 月经过多痛经　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的观察左炔诺孕酮宫内缓释系统(Levonorgestrel-releasing intrauterine system,LNG-IUS,商品名:曼月乐)治疗经量过多和痛经的有效性,比较其单用或与促性腺激素释放激素激动剂(Gonadotropin releasing hormone agonist,GnRHa)联合使用的疗效和副反应。方法我院2007年7月至2013年10月期间因经量过多及/或痛经,诊为子宫腺肌症(341例)、盆腔子宫内膜异位症(68例)和功血(101例)的患者共510例选择安置LNG-IUS作为治疗手段。对这部分患者进行随访(3天-92月,中位随访时间21月)分析。结果87.4%(339/388)的经量过多者治疗后经量有效减少,87.3%(377/432)合并痛经或盆腔疼痛者治疗后疼痛有效缓解。510例患者中,GnRHa联合LNG-IUS治疗者87例(17.1%),单用LNG-IUS治疗者423例(82.9%)。与单用相比,联合GnRHa应用减少经量(91.8%VS.86.5%,P=0.256)、缓解腹痛(91.8%VS.86.5%,P=0.326)的疗效似乎更好,但无统计学意义。两组间放置LNG-IUS后的自然脱落率(9.2%VS.8.5%,P=0.836)亦无统计学差异,不过相对单用而言,联合Gn RHa应用者环自然脱落时间更晚(中位脱落时间10.5月VS.3.5月,P=0.041)、被迫取出率更低(3.4%VS.12.8%,P=0.02),故患者满意度也更高(86.2%VS.75.7%,P=0.032)。结论LNG-IUS不仅具有高效避孕的效果,还能有效减少月经量、缓解痛经和慢性盆腔痛。联合Gn RHa/LNG-IUS与单用LNG-IUS相比,疗效没有显著优势,不过联合应用者LNG-IUS脱落时间更晚、被迫取出率更低、满意度更高。
[Abstract]:Objective to observe the efficacy of Levonorgestrel-releasing intrauterine system LNG-IUSS (trade name: Manyue) in the treatment of menstrual overdose and dysmenorrhea. The efficacy and side effects of gonadotropin releasing hormone agonist GnRHawere compared with those of gonadotropin releasing agonist GnRHa.Methods from July 2007 to October 2013, our hospital suffered from excessive menstrual volume and / or dysmenorrhea. A total of 510 cases of adenomyosis, 68 cases of endometriosis and 101 cases of dysplasia) were treated with LNG-IUS. The patients were followed up for 3 days to 92 months. Analysis of median follow-up time (21 months). Results 87.4% of the patients with overdose (87.4% 339 / 388) were significantly reduced after treatment. (87.3% 377 / 432) pain relief after treatment with dysmenorrhea or pelvic pain. 87 cases were treated with GnRHa combined with LNG-IUS. 87 cases were treated with LNG-IUS alone. Of the 423 cases, 82.9%. Compared with the single use, The combination of GnRHa and VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5P0.836between the two groups seems to be better, but there is no statistical significance. There is no statistical difference between the two groups after placing VS.8.5P0.836), however, there is no statistical difference between the two groups in terms of the natural fall off rate of VS.8.5P0.836. In combination with Gn RHa, the natural exfoliation time of the ring was much later (median abscission time was 10.5 months, VS.3.5 month was 0.041, forced removal rate was lower than 3.4VS.12.8cm), so the patient satisfaction was also higher (86.2VS.75.7P0.032.Conclusion LNG-IUS not only has the effect of effective contraception, but also can effectively reduce the menstrual volume. Compared with LNG-IUS alone, the combination of Gn RHa/LNG-IUS had no significant effect on relieving dysmenorrhea and chronic pelvic pain. However, the patients with combined use of Gn RHa/LNG-IUS had lower rate of forced removal and higher satisfaction with LNG-IUS.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R711.71;R711.51

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