大型弥漫型子宫腺肌病保守性手术及药物治疗综合管理疗效分析

发布时间：2018-06-09 20:32

本文选题：促性腺激素释放激素激动剂 + 子宫腺肌病　；参考：《中国实用妇科与产科杂志》2017年06期

【摘要】：目的探讨保守性手术联合促性腺激素释放激素激动剂(GnRH-a)与左炔诺孕酮宫内缓释系统(LNGIUS)治疗(下称综合治疗)大型弥漫型子宫腺肌病(LDAM)综合管理疗效。方法对2009年3月至2011年9月在复旦大学附属妇产科医院就诊的14例LDAM患者给予综合治疗。LDAM指超声提示子宫长径、前后径、横径中有一单径超过95 mm,或者提示有一单径线达到85~95 mm,而且同时提示子宫内另含较集中的腺肌病病灶≥2个,每个病灶直径均大于35 mm。所有患者用戈舍瑞林3.6 mg腹部皮下注射3个月后行保守性手术,术后延续使用GnRH-a 3个月,相当于第6支GnRH-a注射后28d放置LNG-IUS,并继续随访48个月,观察其疗效、月经模式及副反应。GnRH-a注射期间同时口服中药坤泰胶囊及钙尔奇D片,以减少低雌激素症状与骨量丢失。于GnRH-a治疗前后、放置LNG-IUS后第1年内每3个月和第2、3年每6个月以及第4年末分别随访1次,观察其疗效、月经模式及副反应。结果综合治疗后的12例完成随访,与治疗前相比,子宫平均体积从治疗前410.6 cm3下降到166.3 cm3,内膜厚从8.3 mm下降到6.2 mm,视觉模拟评分法(VAS)评分从8.6分下降到2.9分,血红蛋白从75.0 g/L上升到142.1g/L,血清CA125从78.9k U/L下降到27.1k U/L。其月经模式趋向规则、经量减少并走向月经稀发。其中有2例于放置宫内节育器后第6年已同时实施了取出LNG-IUS并置入新的LNG-IUS术。另有1例放置宫内节育器后18个月脱落,1例放置宫内节育器后36个月取器后自然妊娠。放置宫内节育器期间主要副反应表现为脱落、卵巢囊肿、体重增加、痤疮、乳房胀痛等。结论经腹保守性手术联合GnRH-a与LNG-IUS治疗LDAM是有效、可行的长期综合管理措施。
[Abstract]:Objective to investigate the comprehensive management effect of conservative surgery combined with gonadotropin releasing hormone agonist (GnRH-a) and levonorgestrel intrauterine slow release system (LNGIUS) in the treatment of large diffuse adenomyosis. Methods from March 2009 to September 2011, 14 patients with LDAM who were admitted to the affiliated Obstetrics and Gynecology Hospital of Fudan University were treated with combined therapy. One of the transverse diameters was more than 95 mm, or a single diameter was 85 ~ 95 mm, and it was also suggested that there were more than 2 concentrated adenomyosis lesions in the uterus, and the diameter of each lesion was more than 35 mm. All patients received conservative surgery after 3 months of subcutaneous injection of goserelin 3.6 mg, followed by continuous use of GnRH-a for 3 months, which was equivalent to LNG-IUS28 days after the sixth GnRH-a injection, and was followed up for 48 months to observe the curative effect of GnRH-a. The menstrual model and side effects. GnRH-a were administered orally at the same time as Kuntai capsule and Calcici D tablets in order to reduce the symptoms of low estrogen and the loss of bone mass. The patients were followed up every 3 months and 2 months, 3 years every 6 months and 4 years after LNG-IUS treatment before and after GnRH-a treatment. The curative effect, menstrual pattern and side effects of LNG-IUS were observed. Results 12 cases were followed up. Compared with before treatment, the average volume of uterus decreased from 410.6 cm3 to 166.3 cm 3, the thickness of endometrium decreased from 8.3mm to 6.2mm, and the visual analogue score (VAS) decreased from 8.6mm to 2.9mm. Hemoglobin increased from 75.0 g / L to 142.1 g / L, serum CA125 decreased from 78.9 K / L to 27.1 K / L. Its menstrual pattern tends to be regular, the amount of menstruation decreases and goes to menstrual thinning. In 2 of them, LNG-IUS was removed and a new LNG-IUS was implanted at the same time in 6 years after placement of IUD. In addition, 1 case of IUD fell off 18 months after placement of IUD and 1 case got natural pregnancy after 36 months of IUD placement. The main side effects during IUD placement were exfoliation, ovarian cyst, weight gain, acne, breast pain, etc. Conclusion Transabdominal conservative surgery combined with GnRH-a and LNG-IUS is an effective and feasible long-term comprehensive management measure in the treatment of LDAM.
【作者单位】：复旦大学附属妇产科医院妇科;
【分类号】：R713.4

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