47例左炔诺孕酮宫内缓释系统非避孕作用的临床疗效观察

发布时间：2018-04-29 10:32

本文选题：左炔诺孕酮宫内缓释系统 + 子宫腺肌病　；参考：《吉林大学》2014年硕士论文

【摘要】：目的: 观测左炔诺孕酮宫内缓释系统（LNG-IUS，曼月乐）在非避孕作用方面的临床疗效，并为子宫腺肌病、功能失调性子宫出血（主要为单纯型及复杂型子宫内膜增生）的患者，提供新的治疗思路。材料与方法: 本文选择2012年9月～2014年1月期间在吉林大学第二医院妇产科就诊，要求治病非避孕因素于门诊手术室搁置LNG-IUS的妇女47例。其中，根据临床症状、妇科检查及彩色多普勒超声诊断为子宫腺肌病的患者29例；排除外生殖器及全身器质性病变后诊断为功血的患者18例，其中子宫内膜单纯型增生4例，复杂型增生2例。应用自身配对t检验，子宫腺肌病的患者观察放置LNG-IUS前及放置后第3,6,12个月的月经量改变（PBAC评分）、痛经缓解程度（口述描述评分法VRS）、子宫体积大小变化、血红蛋白含量变化；功血的患者观测放LNG-IUS前及放置后第3,6,12个月的月经改变（包括月经量、月经周期及经期），以及子宫内膜厚度(经阴道妇科彩色多普勒超声所测得的子宫内膜双层厚度)，6例子宫内膜增生的患者，，放置6个月后再次行刮宫，观察病理类型转归情况。另外，观察47例病人放入LNG-IUS后第3,6,12个月阴道不规则出血、下腹痛或腰痛、体重增加等副反应情况。结果: 1、29例因子宫腺肌病放入LNG-IUS的患者中脱环或要求取环共4例，其中1例重新置入后未再脱落，另3例退出研究组。余下的26例患者中，放置LNG-IUS后第3，6,12个月与放置前相比，其PBAC评分及痛经VRS评分均明显降低，差异均有统计学意义(P0.01)。血红蛋白含量（g/l），放置LNG-IUS后第3，6,12个月与放置前相比也均明显上升，差异均有统计学意义(P0.05)。在放入后第3，6个月时子宫体积大小（cm3）较前略有减小，但差异无统计学意义；放入后第12个月时由放前的306.20±75.56降至230.60±49.93，差异有统计学意义（P0.05）。 2、18例功血放置LNG-IUS的患者中，除有1例因置环2个月时随月经血脱落，且因出血量较多造成晕厥立即行手术治疗退出研究组外，其余的17例患者中，置环3个月后月经量PBAC评分、内膜厚度（mm）分别由127.20±18.94、14.20±3.49降至107.00±14.40、9.60±2.19，差异有统计学意义（P0.01）；放置12个月后经期（天）为4.20±1.48，与放置前6.00±1.58相比，经期明显缩短，有统计学意义(P0.01)。置环前后月经周期略有变化，但差异无统计学意义。另外，6例子宫内膜增生的患者，置环6个月后再次行刮宫送病理，结果提示单纯型及复杂型内膜增生改变全部消失，内膜间质呈蜕膜样变。大部分宫内膜腺体呈分泌反应，部分腺体萎缩，无异型性。 3、放置LNG-IUS后主要的不良反应包括不规则阴道出血、下腹部或腰部疼痛、脱环或环下移、卵巢囊肿，少数患者可出现月经稀发、甚至闭经，个别患者出现体重增加、痤疮、面部色素沉着、乳房发胀等内分泌症状。结论: 应用LNG-IUS对于子宫腺肌病的患者，可明显缓解痛经、减少经血、缩小子宫体积、增加血红蛋白含量；对于功能失调性子宫出血的患者，在减少月经量的同时，使子宫内膜厚度明显变薄，经期随着放置时间的延长也逐渐缩短，子宫内膜增生型病变得以治愈，不但降低了手术率，而且保留了生育功能，是一种安全、有效、便捷、经济的治疗方法。同时也存在相应的副反应，如不规则阴道出血、下腹部或腰部疼痛、脱环、闭经及内分泌变化等。
[Abstract]:Objective:
The clinical efficacy of levonorgestrel releasing intrauterine system (LNG-IUS) in the non contraceptive effect was observed, and a new therapeutic idea was provided for the patients with uterine adenomyosis and dysfunctional uterine bleeding (mainly simple and complicated endometrial hyperplasia).
Materials and methods:
In the second hospital of Jilin University from September 2012 to January 2014, we chose 47 cases of LNG-IUS in outpatient operation room. Among them, 29 cases of adenomyosis were diagnosed according to clinical symptoms, gynecologic examination and color Doppler ultrasound, and the external genitals and systemic organic nature were excluded. 18 cases of dysfunctional uterine bleeding were diagnosed after pathological changes, including 4 cases of simple hyperplasia of endometrium and 2 cases of complex hyperplasia. The patients with uterine adenomyosis were used to observe the changes of menstrual volume (PBAC score) before and after 3,6,12 months of placement of adenomyosis (PBAC score), dysmenorrhea (oral description scoring method VRS), and the size of uterus, and the size of uterus was changed, and 18 cases of uterine adenomyosis were observed. Changes in hemoglobin content; menstrual changes before and after LNG-IUS (including menstrual volume, menstrual cycle and menstrual period), and endometrial thickness (double thickness of endometrium measured by color Doppler ultrasound of the vagina), 6 cases of endometrial hyperplasia in patients with endometrium hyperplasia, were placed again after 6 months. In addition, 47 patients with irregular vaginal bleeding, lower abdominal pain or low back pain and weight gain were observed in 47 patients after 3,6,12 months after LNG-IUS.
Result:
Of the patients with adenomyosis in 1,29, 4 cases were removed or required to take the ring in the patients with LNG-IUS, of which 1 cases were replaced and 3 cases were withdrawn from the study group. Among the remaining 26 patients, the PBAC score and the dysmenorrhea VRS score were significantly decreased in the remaining 26 months after placement of LNG-IUS, and the difference was statistically significant (P0.01). The content of erythroprotein (g/l) was significantly increased in 3,6,12 months after placement of LNG-IUS, and the difference was statistically significant (P0.05). The size of the uterus (cm3) decreased slightly at the end of 3,6 months, but the difference was not statistically significant, and the difference was reduced from 306.20 + 75.56 before twelfth months to 230.60 + 49.93. There was a statistical significance (P0.05).
Among the patients with LNG-IUS in 2,18, 1 cases were removed from the study group after 2 months of ring, and the amount of bleeding caused the syncope to quit the study group immediately. In the rest of the 17 patients, the amount of menstrual volume was PBAC score after 3 months, and the thickness of the endometrium (mm) dropped from 127.20 + 18.94,14.20 3.49 to 107 + 14.40,9.60 + 2.1. 9, the difference was statistically significant (P0.01); after 12 months, the menstrual period (day) was 4.20 + 1.48. Compared with 6 + 1.58 before placement, the menstrual period was significantly shortened and had statistical significance (P0.01). There was a slight change in the menstrual cycle before and after the insertion of the ring, but the difference was not statistically significant. In addition, the patients with endometrium hyperplasia in 6 cases were given the curettage again for 6 months. The results showed that all the hyperplasia of endometrium in simple and complex type disappeared, and the endometrium was deciduoid. Most of the endometrium glands were secreted and some glands atrophied and had no atypia.
3, the main adverse reactions after the placement of LNG-IUS include irregular vaginal bleeding, pain in the lower abdomen or waist, dering or ring down, ovarian cysts, a few patients may have menstrual dilute hair, even amenorrhea, individual patients have weight gain, acne, facial pigmentation, breast distention and other endocrine symptoms.
Conclusion:
LNG-IUS for patients with adenomyosis can obviously relieve dysmenorrhea, reduce menstrual blood, reduce the volume of uterus and increase the hemoglobin content; for patients with dysfunctional uterine bleeding, the thickness of the endometrium is obviously thinner while the menstrual volume is reduced, and the menstrual period is gradually shortened with the prolongation of the time of placement and the endometrium hyperplasia. The disease is cured. It not only reduces the rate of operation, but also preserves the fertility function. It is a safe, effective, convenient and economical treatment. It also has the corresponding side effects, such as irregular vaginal bleeding, lower abdomen or waist pain, dering, amenorrhea and internal secretion.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.52;R711.71

【参考文献】