CAJ | 학술논문

目的：探讨促性腺激素释放激素激动剂（Gonadotropin-releasing hormone analogue-A，GnRH-a）联合左炔诺孕酮宫内释放系统（levonorgestrel intrauterinesystem，LNG-IUS；曼月乐环）治疗子宫腺肌症（Adenomyosis，AM）的疗效。方法对2009年1月～2011年6月在我院就诊的25例AM患者给予GnRHa联合LNG-IUS治疗；所有患者用戈舍瑞林3.6 mg皮下注射，6个月后放置LNG-IUS，并继续随访30个月。于治疗前（B）、6针GnRHa后的第28天，即放置LNG-IUS前（G6），LNG-IUS后第1个月（L1）、3个月（L3）、6个月（L6）、9个月（L9）、12个月（L12）、18个月（L18）、24个月（L24）、30个月（L30）观察其疗效（子宫体积、内膜厚度、痛经VAS评分、血红蛋白变化）、月经模式及副反应。结果在GnRHa6个月及联合曼月乐环12个月内子宫体积较治疗前明显缩小，此后随访至30个月，子宫体积逐渐增大，但与治疗前比较，差异无统计学意义（P＞0.05）；在联合治疗36个月的随访期内，与治疗前相比，内膜厚度明显变薄、痛经症状明显缓解，血红蛋白明显升高；其月经模式表现为不规则阴道出血改善、月经趋向规则、经量减少并走向月经稀发与闭经。其主要的副反应表现为环脱落（4%）、卵巢囊肿、体重增加、痤疮、乳房胀痛等。结论本研究提示GnRHa联合LNG-IUS治疗AM可明显的缓解痛经，改善月经过多，对控制子宫体积也有一定作用，副反应较轻，尤其适用于要求保留子宫的较大型子宫腺肌症患者。
목적：탐토촉성선격소석방격소격동제（Gonadotropin-releasing hormone analogue-A，GnRH-a）연합좌결낙잉동궁내석방계통（levonorgestrel intrauterinesystem，LNG-IUS；만월악배）치료자궁선기증（Adenomyosis，AM）적료효。방법대2009년1월～2011년6월재아원취진적25례AM환자급여GnRHa연합LNG-IUS치료；소유환자용과사서림3.6 mg피하주사，6개월후방치LNG-IUS，병계속수방30개월。우치료전（B）、6침GnRHa후적제28천，즉방치LNG-IUS전（G6），LNG-IUS후제1개월（L1）、3개월（L3）、6개월（L6）、9개월（L9）、12개월（L12）、18개월（L18）、24개월（L24）、30개월（L30）관찰기료효（자궁체적、내막후도、통경VAS평분、혈홍단백변화）、월경모식급부반응。결과재GnRHa6개월급연합만월악배12개월내자궁체적교치료전명현축소，차후수방지30개월，자궁체적축점증대，단여치료전비교，차이무통계학의의（P＞0.05）；재연합치료36개월적수방기내，여치료전상비，내막후도명현변박、통경증상명현완해，혈홍단백명현승고；기월경모식표현위불규칙음도출혈개선、월경추향규칙、경량감소병주향월경희발여폐경。기주요적부반응표현위배탈락（4%）、란소낭종、체중증가、좌창、유방창통등。결론본연구제시GnRHa연합LNG-IUS치료AM가명현적완해통경，개선월경과다，대공제자궁체적야유일정작용，부반응교경，우기괄용우요구보류자궁적교대형자궁선기증환자。
ObjectiveTo evaluate the clinical outcomes of gonadotropin-releasing hormone analog (GnRHa) combined with implantation of a levonorgestrel-releasing intrauterine system(LNG-IUS) in adenomyosis patients with signiifcantly enlarged uteruses.MethodsTwenty-ifve adenomyosis patients from January 2009 to June 2011 at Fudan University Obstetrics and Gynecology hospital were recruited for the study .Before treatment (B), the ifrst 28 days after injected of GnRHa at the sixth cycles , before the LNG-IUS was placed(G6), , the ifrst LNG-IUS after a month (L1), 3 months (L3), 6 months (L6 ) , 9 months (L9), 12 months (L12), 18 months (L18), 24 months (L24), 30 months (L30) to observe its effect ( uterine volume , endometrial thickness ,dysmenorrhea VAS score hemoglobin changes ) , menstrual pattern and side effects.Resultsthe six months of GnRHa and within 12 months of LNG-IUS uterine volume was signiifcantly reduced compared with before treatment , then followed up to 30 months, uterine volume increases , but no statistically signiifcant before treatment; In combination therapy 36 month follow-up period, compared with before treatment, endometrial thickness was significantly thinner , dysmenorrhea symptoms were relieved , hemoglobin was signiifcantly increased, and there is a signiifcant difference .Menstrual pattern characterized by irregular vaginal bleeding to improved, menstrual tends to be regular, Menstrual quantity decreases and tends to be oligomenorrhea or amenorrhea,The main side effects showed an expulsion of LNG-IUS (4%), ovarian cysts , weight gain , acne, and breast tenderness.ConclusionThis study suggests that GnRHa combined with LNG-IUS therapy can signiifcantly relieve dysmenorrhea, improve menorrhagia, have an important role in controlling inuterine volume, few side effects , especially for applications that require retention the uterus of adenomyosis patients.