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目的研究促性腺激素释放激素激动剂(GnRH-a)联合左炔诺孕酮宫内释放系统(LNG-IUS)治疗子宫腺肌症(AM)的效果。方法选取该院2014年9月-2015年9月门诊及住院部收治的96例患者,根据患者自愿原则分为对照组和观察组,对照组采取直接放置LNG-IUS,观察组采取GnRH-a联合LNG-IUS。对比两组的痛经程度、月经量评分、子宫体积、CA125、阴道流血情况、脱环的情况。结果注射后观察组子宫体积为(157.28±17.20)cm~3,显著低于注射前的(227.65±28.21)cm~3,差异有统计学意义(t=8.927,P<0.001);注射后CA125为(39.37±8.9)U/ml,显著低于注射前的(78.27±18.29)U/ml,差异有统计学意义(t=7.281,P<0.001);放置LNG-IUS 6个月后,观察组的子宫体积为(133.25±22.91)cm~3,显著低于对照组的(189.27±28.37)cm~3,差异有统计学意义(t=8.281,P<0.001);观察组的月经量评分为(18.93±10.38)分,显著低于对照组的(43.28±11.28)分,差异有统计学意义(t=7.284,P<0.001);观察组痛经程度轻于对照组,差异有统计学意义(Z=1.998,P<0.05);观察组CA125>35 U/ml例数为4例,明显低于对照组的22例,差异有统计学意义(χ~2=9.203,P<0.01);放置LNG-IUS 6个月,观察组阴道流血淋漓不尽为0例,低于对照组的9例,差异有统计学意义(χ~2=26,P<0.05);观察组脱环为5例,低于对照组的7例,差异无统计学意义(χ~2=12.5,P>0.05)。结论 GnRH-a联合LNG-IUS能有效缓解痛经,并控制阴道出血和减少子宫体积,值得在临床中推广。
Objective To investigate the effect of GnRH-a and levonorgestrel releasing intrauterine release system (LNG-IUS) on adenomyosis (AM). Methods Ninety-six patients in our hospital from September 2014 to September 2015 were selected and divided into control group and observation group according to the voluntary principle of patients. LNG-IUS was placed in control group and GnRH-a Joint LNG-IUS. The degree of dysmenorrhea, menstrual volume score, uterine volume, CA125, vaginal bleeding and deprotonation were compared between the two groups. Results The volume of uterus in the observation group after injection was (157.28 ± 17.20) cm ~ (3), which was significantly lower than that before injection (227.65 ± 28.21) cm ~ 3 (t = 8.927, (39.37 ± 8.9) U / ml was significantly lower than that before injection (78.27 ± 18.29) U / ml, the difference was statistically significant (t = 7.281, P <0.001) (133.25 ± 22.91) cm ~ 3, which was significantly lower than that of the control group (189.27 ± 28.37) cm ~ 3, the difference was statistically significant (t = 8.281, P <0.001) (18.93 ± 10.38), significantly lower than that of the control group (43.28 ± 11.28), the difference was statistically significant (t = 7.284, P <0.001). The degree of dysmenorrhea in the observation group was lighter than that in the control group (Z = 1.998, P <0.05). The number of CA125> 35 U / ml in the observation group was 4 cases, which was significantly lower than that in the control group (χ ~ 2 = 9.203, P <0.01). Six months after the LNG-IUS was placed, vaginal bleeding was observed in 0 cases in observation group, which was significantly lower than that in control group (χ ~ 2 = 26, P <0.05) Cases, lower than the control group of 7 cases, the difference was not statistically significant (χ ~ 2 = 12.5, P> 0.05). Conclusion GnRH-a combined with LNG-IUS can effectively relieve dysmenorrhea, control vaginal bleeding and reduce uterine volume, which is worth to be popularized clinically.