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目的:探讨宫腔镜子宫肌内膜切除联合孕三烯酮治疗子宫腺肌病的临床价值。方法:将63例子宫肌腺症患者随机分为研究组42例和对照组21例。两组均采用宫腔镜下子宫内膜电切术(TCRE)切除子宫内膜全层基底膜及其下方部分肌层组织,研究组术后予孕三烯酮治疗12个月。两组术后均随访24个月,观察月经量、血红蛋白水平、痛经评分、子宫体积、血CA125、复发率和并发症。结果:术后随访24个月,研究组的月经量、血红蛋白水平、痛经评分、子宫体积与对照组比较差异有统计学意义(P<0.01),子宫体积缩小程度明显优于对照组(P<0.01),血CA125下降值两组比较差异有统计学意义(P<0.01);复发率(50.00%)明显低于对照组(13.97%)(P<0.01)。研究组患者的并发症主要为孕三烯酮所致轻度肝功能异常。结论:宫腔镜子宫肌腺病内膜切除联合孕三烯酮治疗子宫腺肌病安全、疗效显著、复发率低,是保守治疗子宫肌腺症的有效方式。
Objective: To investigate the clinical value of hysteroscopic endometrial resection combined with gestrinone in the treatment of adenomyosis. Methods: 63 cases of adenomyosis were randomly divided into study group 42 cases and control group 21 cases. Hysteroscopic endometrial resection (TCRE) was used to excise the whole basement membrane of the endometrium and some of the musculature below, and the study group was treated with gestrinone for 12 months. The two groups were followed up for 24 months. The menstrual flow, hemoglobin level, dysmenorrhea score, uterine volume, blood CA125, recurrence rate and complications were observed. Results: After 24 months of follow-up, the menstrual volume, hemoglobin level, dysmenorrhea score and uterine volume in the study group were significantly different from those in the control group (P <0.01), and the degree of uterine contractions was significantly better than that in the control group (P < 0.01). There was significant difference between the two groups (P <0.01). The recurrence rate (50.00%) was significantly lower than that of the control group (13.97%) (P <0.01). The main complication in study group was mild hepatic dysfunction caused by gestrinone. Conclusion: Hysteroscopic adenomyosis intima resection combined with gestrinone treatment of adenomyosis safety, significant effect, low recurrence rate, conservative treatment of adenomyosis is an effective way.