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目的探讨宫腔镜下病灶切除术联合宫腔内左炔诺孕酮释放系统(LNG-IUS)治疗内突型子宫腺肌瘤的近中期临床疗效。方法对2014-01-01—2015-04-31期间大连医科大学附属大连市妇幼保健院18例子宫腺肌瘤患者行宫腔镜下病灶切除术联合LNG-IUS治疗,记录手术时间、术中及术后并发症情况,比较术前及术后的痛经改善情况、月经量的变化、子宫体积的变化及子宫腺肌瘤复发情况。结果 18例宫腔镜下子宫腺肌瘤病灶切除术手术时间(58.3±6.4)min,无术中、术后并发症。术后随访6~12个月。14例痛经患者,2例(2/14,14.3%)部分缓解,5例(5/14,35.7%)明显缓解,5例(5/14,35.7%)完全缓解,2例(2/14,14.3%)无月经来潮。14例经量多者,术后经量均减少、经期缩短,且差异有统计学意义[为术前的(29.3±0.7)%,P<0.05];月经周期术前术后差异无统计学意义[(7.8±3.3)d vs.(4.3±2.2)d,P>0.05]。10例合并不同程度贫血者贫血均纠正。术后6个月子宫体积均缩小,且差异有统计学意义[(232.5±94.5)cm3vs.(123.8±59.4)cm3,P<0.05],随访期间彩超均未提示子宫腺肌瘤复发。8例(8/18)术后阴道分泌物量多、稀薄;4例(4/18)术后3个月内有点滴阴道流血,均于3~6个月渐恢复正常;1例(1/18)体重增加。2例(2/18)因阴道分泌物较多表示满意度欠佳,余均满意。结论宫腔镜下子宫腺肌瘤病灶切除术联合LNG-IUS治疗内突型子宫腺肌瘤近中期疗效明显。
Objective To investigate the clinical efficacy of hysteroscopic resection combined with intrauterine levonorgestrel release system (LNG-IUS) in the treatment of endometrioid adenomyosis. Methods 18 cases of adenomyosis of the uterus in Dalian Maternal and Child Health Hospital affiliated to Dalian Medical University during 2014-01-01-2015-04-31 underwent hysteroscopic resection combined with LNG-IUS treatment. The operative time, Postoperative complications were compared before and after the improvement of dysmenorrhea, menstrual volume changes, uterine volume changes and recurrence of adenomyosis. Results 18 cases of hysteroscopic adenomyosis resection operation time (58.3 ± 6.4) min, no intraoperative and postoperative complications. Follow-up 6 to 12 months after operation. In 14 cases of dysmenorrhea, 2 cases (2/14, 14.3%) were partly relieved, 5 cases (5 / 14,35.7%) were relieved, 5 cases (5 / 14,35.7% , 14.3%) had no menstrual cramps. There were no significant differences in the menstrual cycle between 14 preoperative and postoperative menstrual cycles (14.3 ± 0.7%, P <0.05), and the difference was statistically significant Significance [(7.8 ± 3.3) d vs. (4.3 ± 2.2) d, P> 0.05]. 10 cases of anemia combined with varying degrees of anemia were corrected. Uterine volume decreased at 6 months after operation, and the difference was statistically significant [(232.5 ± 94.5) cm3 vs (123.8 ± 59.4) cm3, P <0.05]. No recurrence of uterine adenomyosis was detected by color Doppler ultrasound during follow-up. Vaginal discharge was more and thinner in 8 cases (8/18). In 4 cases (4/18), vaginal bleeding was dripped within 3 months after operation, which returned to normal in 3 ~ 6 months. One case (1 / 18) Weight gain. 2 cases (2/18) due to more vaginal discharge, unsatisfactory, I was satisfied. Conclusion hysteroscopic adenomyosis resection combined with LNG-IUS treatment of endometriosis adenomyoma obvious effect in the near and midterm.