子宫腺肌病内膜电切术后放置曼月乐临床效果的研究(1)
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[摘要] 目的 通过应用宫腔镜子宫内膜电切术(TCRE)联合术后宫内放置左炔诺孕酮宫内缓释系统(LNG-IUS，商品名：曼月乐)治疗子宫腺肌病的临床效果的研究，寻找子宫腺肌病保守性手术治疗的理想方案。方法 对168例月经过多伴痛经且要求保留子宫的腺肌病患者，经随机抽样分为联合组(子宫内膜电切术+放置曼月乐组)和电切组(子宫内膜电切术组)进行对照观察，并分别于术后1个月、3个月、6个月、12个月、24个月、36个月随访观察痛经(VAS评分)、PBAC评分。结果 联合组痛经的改善、闭经、复发率的降低等指标均较电切组有明显优势，差异有统计学意义(P<0.05)。结论 TCRE联合曼月乐既解决患者单独放置曼月乐引起的不规则出血及依从性差问题，又弥补了TCRE术后易复发的问题。两者结合可起到优势互补的作用，是一种可靠而有效的治疗方法，有较好的临床推广应用价值。
[关键词] 子宫腺肌病；子宫内膜电切术；左炔诺孕酮宫内缓释系统
[中图分类号] R711.71 [文献标识码] B [文章编号] 1673-9701(2011)26-37-03
Clinical Study of Adenomyosis Placed LNG-IUS after Transcervical Resection of Endometrium
LI Dingheng ZHANG Min LIN Feng DING Jianhong
Department of Gynecology and Obstetrics， Zhejiang Xiaoshan Hospital， Hangzhou 311201， China
[Abstract] Objective To search the ideal solution for adenomyosis conservative surgery through the research on application of hysteroscopic endometrial resection (TCRE) and postoperative intrauterine levonorgestrel-releasing intrauterine system (LNG-IUS， trade name： Mirena) in treatment of adenomyosis. Methods One hundred sixty eight cases of dysmenorrhea and menorrhagia associated with adenomyosis patients who wanted to retain uterus randomly divided into combined group (endometrial resection + place IUS group) and the transurethral group (endometrial resection surgery group) were observed， respectively； Dysmenorrhea (VAS score) and PBAC score were observed after 1 month， 3 months， 6 months， 12 months， 24 months， 36 months follow-up. Results The combined group had obvious advantages than TURP group in improving indicators such as dysmenorrhea， amenorrhea and lower recurrence rate， and the differences were statistically significant (P<0.05). Conclusion TCRE combined IUS will resolve the problems of irregular bleeding and poor compliance caused by Mirena placed alone in patients， and make up the problem of postoperative recurrence for TRCE. Combination of both can play a complementary role， is a reliable and effective treatment method with better clinical application value.
[Key words] Adenomyosis； Transcervical resection of endometrium； Levonorgestrel releasing intrauterine system ......
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