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目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS;商品名:曼月乐)对子宫内膜不典型增生的临床治疗效果。方法:采用前瞻性自身对照研究对9例子宫内膜不典型增生患者放置LNG-IUS后,每隔3个月取出LNG-IUS后诊刮,再将LNG-IUS重新置入,直至子宫内膜逆转厚再行1~2次治疗,观察子宫内膜逆转时间、内膜厚度及月经量改善情况,必要时宫腔镜检查。结果:经量评分放置LNG-IUS前为127.9±41.4,放置后3个月、6个月及12个月分别为36.2±12.8、20.4±8.1及1615.9±6.2,与放置前比较均有统计学差异(P<0.01),放置LNG-IUS前B超检查内膜厚度为14.9±4.2 mm,放置后3个月、6个月及12个月子宫内膜厚度分别为8.4±2.0 mm、6.0±2.6 mm及5.4±1.2 mm,与放置前比较均有显著统计学差异(P<0.01)。放置LNG-IUS 3个月后9例中有4例病理显示内膜不典型增生改变消失,6个月后6例内膜不典型增生改变消失,9月后全部患者内膜完全逆转成正常。结论:LNG-IUS能逆转子宫内膜不典型增生,严密随访下可作为对子宫内膜不典型增生患者,尤其是需要保留生育能力患者的一种较为有效且安全的保守治疗选择。
Objective: To investigate the clinical effect of levonorgestrel-releasing intrauterine system (LNG-IUS; trade name: Mirena L) on dysplasia of endometrium. METHODS: Nine patients with atypical hyperplasia of endometrium were placed LNG-IUS in a prospective, self-controlled study. LNG-IUS was removed at 3-month intervals and LNG-IUS was reinserted until the endometrium Reversal of thick and then line 1 or 2 times the treatment, observation of endometrial reversal time, endometrial thickness and improvement of menstrual situation, if necessary, hysteroscopy. Results: The volume score was 127.9 ± 41.4 before LNG-IUS placement, 36.2 ± 12.8, 20.4 ± 8.1 and 1615.9 ± 6.2 at 3 months, 6 months and 12 months after placement, respectively (P <0.01). The thickness of endometrium before LN-IUS was 14.9 ± 4.2 mm, and the endometrial thickness at 3, 6 and 12 months after placement was 8.4 ± 2.0 mm and 6.0 ± 2.6 mm and 5.4 ± 1.2 mm, respectively, which were significantly different from those before the operation (P <0.01). After 3 months of LNG-IUS placement, 4 of 9 cases showed disappearance of atypical hyperplasia, 6 cases of atypical hyperplasia of 6 cases disappeared after 6 months, and all patients had complete reversal of intima after 9 months. CONCLUSION: LNG-IUS can reverse atypical hyperplasia of endometrium, which can be used as a more effective and safe conservative treatment option for patients with endometrial dysplasia, especially those who need to retain fertility.