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目的:研究比较左炔诺孕酮宫内缓释系统(LNG-IUS)和孕三烯酮2种方法治疗子宫腺肌病的临床疗效及不良反应。方法:选择60例子宫腺肌病患者为研究对象,随机分为观察组和对照组,观察组(n=30)行宫腔内放置LNG-IUS治疗,对照组(n=30)给予口服孕三烯酮治疗。观察治疗前、治疗后1个月、3个月、6个月、12个月、24个月的痛经程度、月经量、子宫内膜厚度和体积及相关不良反应;痛经程度用视觉模拟评分(VAS)评估。结果:观察组和对照组治疗痛经、月经过多以及子宫内膜增厚的疗效均良好,与治疗前比较有统计学差异(P<0.05);观察组与对照组比较VAS评分、月经量、子宫内膜厚度均明显减少,观察者和对照组间比较(除了治疗6个月)差异有统计学意义(P<0.05);对照组患者停药后上述指标均有回升,而观察组均稳定维持低值;治疗后患者的子宫体积仅略有缩小,但与治疗前比较差异均无统计学意义(P>0.05)。对照组不良反应有体质量增加、痤疮、潮热及肝、肾功能损伤等,而观察组的主要不良反应主要为放置后不规则阴道流血和闭经,阴道流血一般3个月后可以自行停止。观察组其余的不良反应较对照组相对略少,无统计学差异。结论:LNGIUS较孕三烯酮能更有效地治疗子宫腺肌病患者的症状,且不良反应少,具有长效、创伤小、可逆性和平均费用低的优势,且有避孕效果,可考虑作为首选的保守治疗方法。
Objective: To compare the clinical efficacy and side effects of two methods of levonorgestrel intrauterine system (LNG-IUS) and gestrinone in the treatment of adenomyosis. Methods: Sixty patients with adenomyosis were enrolled in this study. Patients in the observation group were randomly divided into observation group (n = 30) and LNG-IUS group (n = 30) Enone treatment. The degree of dysmenorrhea, menstrual flow, endometrial thickness and volume and related adverse reactions were observed before treatment, 1 month, 3 months, 6 months, 12 months and 24 months after treatment. The severity of dysmenorrhea was assessed by visual analogue scale VAS) evaluation. Results: The curative effect of treating dysmenorrhea, menorrhagia and endometrial thickening in observation group and control group were all good (P <0.05), the VAS score, menstruation volume, Endometrial thickness were significantly reduced, the difference between the observer and the control group (except for 6 months) was statistically significant (P <0.05); the control group patients after stopping the above indicators were recovered, while the observation group were stable After treatment, the uterus volume of patients decreased only slightly, but there was no significant difference between before and after treatment (P> 0.05). Adverse reactions in the control group were increased body mass, acne, hot flashes and liver and renal dysfunction. The main adverse reactions in the observation group were irregular vaginal bleeding and amenorrhea after vaginal discharge. The vaginal bleeding usually stopped after 3 months. The remaining adverse reactions in the observation group were slightly less than those in the control group, with no significant difference. CONCLUSIONS: Compared with gestrinone, LNGIUS is more effective in the treatment of patients with adenomyosis and has fewer side effects. It has the advantages of long-term efficacy, small trauma, reversible and low average cost, and has the effect of contraception, and can be considered as Preferred conservative treatment.