左炔诺孕酮宫内缓释系统对子宫腺肌病疗效的临床观察

发布时间：2018-05-10 12:54

本文选题：子宫腺肌病 + 左炔诺孕酮宫内缓释系统　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:子宫腺肌病是妇科的常见疾病。近年来发病率呈上升趋势,且发病人群逐渐趋于年轻化。子宫腺肌病的临床表现主要为继发性痛经呈进行性加重,可伴月经过多,已严重影响育龄妇女生活质量。药物治疗有假绝经疗法和假孕疗法,均可使子宫内膜萎缩,改善症状。但是药物治疗存在较多副反应,患者往往难以坚持使用,依从性较差。因此患者在药物治疗无效情况下多进行子宫切除术。手术治疗虽然疗效显著,但是亦存在相应的手术风险及卵巢血供减少进而影响卵巢功能等并发症。故此选择一种既副作用少又创伤小的治疗方法变得十分重要。左炔诺孕酮宫内缓释系统(Levonorgestrel-releasing intrauterine system,LNG-IUS,商品名:曼月乐)可以在5年的有效期内向宫腔恒定地释放左炔诺孕酮(levonorgestrel,LNG),对子宫腺肌病有持续治疗的作用。本文对曼月乐治疗子宫腺肌病的疗效、不良反应及满意度方面进行观察研究,以指导临床。方法:本文选择2013年1月至2014年6月来我院妇科门诊就诊的46例子宫腺肌病患者。痛经程度采用视觉模拟评分法(Visual analogue scale,VAS)评估,月经血量采用月经失血图(pictorial blood loss assessment chart,PBAC)评估,刺激性、压力性及梗阻性的尿路症状采用泌尿生殖影响量表(Urinary distress inventory 6,UDI-6)评估。观察患者放置曼月乐第3、6个月的VAS、PBAC、HGB、CA125、UDI-6变化,以及出现的不良反应和使用的满意度。采用SPSS19.0统计学软件对资料进行正态性检验,满足正态性的采用t检验,各组数据用?x±s表示;不满足正态性的采用非参数Wilcoxon秩和检验,数据用中位数M(P25,P75)的形式表示。以P0.05为差异有统计学意义。结果:46例患者中1名患者失访,1名患者因曼月乐放置2周后脱落而行药物治疗,1名患者因上环2个月后月经量及贫血程度未见明显改善而行手术治疗。4名患者出现环下移再次重新放置,共有43名患者完成为期6个月的随访观察。1痛经情况:患者放置曼月乐后症状有明显缓解,对放置前与放置后第3、6个月的VAS评分进行分析,由放置前2(2,3)分别降为0(0,1)、0(0,0),差异均有统计学意义(P均0.01)。痛经缓解率及治愈率:①放置后3个月有42例患者痛经症状明显缓解,即痛经缓解率为97.67%(42/43),其中有22例患者痛经症状完全消失,治愈率为51.16%(22/43);②放置后6个月43例患者痛经症状均有缓解,即痛经缓解率为100%,其中76.74%(33/43)患者痛经症状完全消失。2月经量(PBAC)评分及血红蛋白含量(HGB):放置曼月乐前月经量PBAC评分为216.70±47.10,放置曼月乐后第3、6个月的PBAC评分分别降至74.63±16.38,49.26±22.27,差异均有统计学意义(P0.01)。放置前18例贫血患者的HGB为109.80±6.23g/L,放置后第3、6个月HGB分别为118.70±6.94g/L和126.14±6.65g/L,与放置前相比差异有统计学意义(P0.01)。3血清CA125:放置前为65.35±11.37U/ml,放置后第3、6个月时分别降为54.21±9.44U/ml和47.04±8.19U/ml,差异与放置前相比,均有统计学意义(P0.01)。4 UDI-6评分:放置曼月乐后6个月,15例患者在刺激性、压力性和梗阻性尿路评分上的改善率分别为26.67%,13.33%,20.00%。刺激症状及总尿路评分有显著差异,P值0.05。5不良反应及满意度:阴道点滴出血是最主要的不良反应。在随访期间共有18例(41.86%)患者出现经间期阴道点滴出血。有4例(9.3%)患者放置后6个月出现闭经。有4例放置曼月乐后发现环位置下移,1例出现脱环。有2例(4.65%)患者出现单侧卵巢囊肿。有2例(4.65%)患者在随访至3个月时出现行经期间乳房胀痛。有1例(2.32%)患者随访至5个月时出现面部痤疮。患者满意度较高,表示不满意的患者占4.65%。结论:曼月乐治疗子宫腺肌病虽然存在相应的副反应,但是疗效显著,患者满意度较高。
[Abstract]:Objective: adenomyosis is a common disease of gynecology. In recent years the incidence of adenomyosis is rising, and the incidence of the disease is gradually becoming younger. The clinical manifestations of adenomyosis are secondary dysmenorrhea, which can be accompanied by excessive menstruation, which have seriously affected the quality of life of women of childbearing age. There are false menopause and pseudo pregnancy therapy in the treatment of drugs. It can make the endometrium atrophy and improve the symptoms. But there are many side effects in the drug treatment, and the patient is often difficult to adhere to, and the compliance is poor. Therefore, the patient has more hysterectomy under the condition of ineffective drug treatment. Although the surgical treatment is effective, there are corresponding surgical risks and the decrease of the ovarian blood supply and then the ovary. It is important to choose a treatment with less side effects and less trauma. Levonorgestrel-releasing intrauterine system (LNG-IUS system) can release levonorgestrel (levonorgestrel, LNG) continuously to the uterine cavity in the period of 5 years of validity. The effect, adverse reaction and satisfaction of the patients with adenomyosis in the treatment of uterine adenomyosis were observed and studied to guide the clinical. Methods: 46 cases of adenomyosis in gynecologic outpatient of our hospital from January 2013 to June 2014 were selected. The degree of dysmenorrhea was evaluated by visual analogue scale (Visual Analogue scale, VAS) evaluation of menstrual blood volume (Pictorial blood loss assessment chart, PBAC) assessment, irritant, stressful, and obstructive urinary tract symptoms (Urinary distress inventory 6) assessment. SPSS19.0 statistics software is used to test the data in normality to satisfy the normality by using t test. The data of each group is represented by X + s; the non parametric Wilcoxon rank sum test is adopted and the data is expressed in the form of the median M (P25, P75). Results: of the 46 patients, 1 of the 46 patients were lost and 1 patients were treated with malanle 2 weeks later. 1 patients underwent surgical treatment for 2 months after the upper ring and no significant improvement in the degree of anemia. A total of 43 patients underwent a 6 month follow-up of 6 months of follow-up. After placement, the symptoms of the patients were significantly relieved, and the VAS scores before and after the placement of the 3,6 month were analyzed, which were reduced to 0 (0,1) and 0 (0,0) before placement 2 (2,3). The difference was statistically significant (P 0.01). The remission rate and cure rate of the dysmenorrhea were: (1) 42 cases of dysmenorrhea symptoms were significantly relieved in 3 months after placement, that is, the pain of dysmenorrhea. The rate of solution was 97.67% (42/43), of which 22 cases disappeared completely and the cure rate was 51.16% (22/43). 43 cases of dysmenorrhea were relieved in 6 months after placement, that is, the remission rate of dysmenorrhea was 100%, of which 76.74% (33/43) patients completely disappeared.2 menstrual volume (PBAC) score and hemoglobin content (HGB): pre Meno meniera menorrhagia was placed. The score of PBAC was 216.70 + 47.10. The PBAC score of 3,6 months after placement was 74.63 + 16.38,49.26 + 22.27 respectively. The difference was statistically significant (P0.01). The HGB of 18 patients with anemia before placement was 109.80 + 6.23g/L, and the HGB was 118.70 + 6.94g/L and 126.14 + 6.65g/L after placement, and the difference was statistically significant compared with that before placement. The serum CA125: of.3 was 65.35 + 11.37U/ml before placement, and decreased to 54.21 + 9.44U/ml and 47.04 + 8.19U/ml at 3,6 months after placement. The difference was statistically significant (P0.01).4 UDI-6 score compared with that before placement: 6 months after placement, 15 patients were improved on the irritant, stressful and obstructive urinary tract scores. There was a significant difference between 26.67%, 13.33%, 20.00%. irritation symptoms and total urinary tract scores, P value 0.05.5 adverse reactions and satisfaction: vaginal drip bleeding was the most important adverse reaction. During the follow-up period, 18 cases (41.86%) had intermenstrual vaginal bleeding. 4 cases (9.3%) had amenorrhea 6 months after placement. 4 cases were placed in menopause. 1 cases of unilateral ovarian cysts were found in 2 cases (4.65%). 2 patients (4.65%) had menstrual swelling pain during the follow-up to 3 months. There were 1 (2.32%) patients who were followed up to 5 months to face acne. The patients were satisfied with the 4.65%. conclusion: the patients who were dissatisfied accounted for the treatment of the moon. Although adenomyosis has corresponding side effects, the curative effect is significant and patient satisfaction is high.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R711.71

【引证文献】