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

发布时间：2018-04-22 19:44

本文选题：子宫腺肌病 + 曼月乐　；参考：《上海交通大学学报(医学版)》2017年05期

【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)mm~3 vs(213.7±38.6)mm~3]。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%vs12.50%),2组比较差异均有统计学意义(P0.05)。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。
[Abstract]:Objective to investigate the clinical value of hysteroscopic endometrial resection combined with levonorgestrel intrauterine birth control system (Manyue) in the treatment of adenomyosis. Methods 112 patients with myometriosis were randomly divided into combined group and manyue group according to 1:1. The combined group was treated with TCRE under hysteroscopy and intrauterine manyue was placed after operation, while Manyue group was treated with manyue alone. After 36 months follow-up, menstrual volume, hemoglobin level, dysmenorrhea score, uterine volume, blood CA125 level and complications were observed. Results the average follow-up time was 42 months. The pass rate was 73.21 in the combined group and 50.00in the Manyue group. The menstrual volume, hemoglobin level, blood CA125 level and dysmenorrhea score were significantly decreased in the 2 groups at 3 ~ 36 months after operation, and the uterine volume was significantly reduced in 6 ~ 12 months after operation, which was significantly different from that before operation. The reduction of uterine volume in the combined group 24 months after operation was significantly better than that in the Manyuelo group [171.3 卤34.8)mm~3 vs(213.7 卤38.6)mm~3]. The rate of hysterectomy, the rate of annular exfoliation, the rate of breakthrough bleeding and the incidence of irregular vaginal hemorrhage in the group of Manyue were higher than those in the group of combined group (12.50 vs 5.360.16.07 vs 5.360.83 vs 3.572.25vs 3.572.25vs12.5050m). There were significant differences in the common adverse reactions between the two groups (P 0.05.2). The difference was not statistically significant. Conclusion TCRE combined with Manyuelo is an effective method for the treatment of adenomyosis. It can significantly reduce the irregular vaginal bleeding caused by simple placement of Manyuelo and is an effective method for the conservative treatment of adenomyosis.
【作者单位】：上海市浦东新区妇幼保健院妇产科;
【基金】：上海市卫生局科研项目(20114140)~~
【分类号】：R713.4

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