子宫肌腺症药物保守治疗的分级方案选择初探方芳刘双萍王晓娟.docVIP

子宫肌腺症保守治疗的分级方案选择初探 方芳 刘双萍 王晓娟 林晓龙 [摘要] 目的 观察促性腺激素释放激素激动剂（GnRHa）和左炔诺孕酮宫内节育系统（LNG-IUS）分级治疗方案对于子宫不同程度增大的子宫肌腺症的疗效。方法 采用GnRHa和LNG-IUS联合应用的不同方案治疗子宫增大程度不同的子宫肌腺症并随访36个月，观察对缩小子宫体积、缓解痛经、降低血CA125水平的作用及治疗转归。结果 对子宫体平均径线不超过65mm者，单用曼月乐及联合GnRHa治疗均可缓解痛经（p0.05）并持续36个月以上，可减小子宫体积达24个月。对子宫平均径线在65mm~85mm者，GnRHa3针后联合曼月乐治疗第一个月即可缩小子宫且持续12个月；抑制痛经作用持续时间达36个月。对子宫平均径线超过85mm者，GnRHa6针后联合曼月乐治疗可快速缩小子宫并持续至放环后6个月；抑制痛经效果可持续至放环后12个月。GnRHa治疗3针可使血CA125水平从113.5±97.1U/ml降为23.2±5.1U/ml（p0.05）；单用曼月乐可在6个月内使CA125水平从63.5±21.6U/ml降为30.8±12.3U/ml（p0.05）。结论 GnRHa可快速缩小子宫、抑制痛经及降低CA125水平曼月乐。GnRHa-曼月乐治疗对于子宫轻到中度增大者疗效可维持至少2~3年，但对子宫重度增大者持续时间不到2年。 [关键词] 子宫肌腺症 保守治疗 GnRHa 左炔诺孕酮宫内节育系统 Classified conservative treatment of adenomyosis—a preliminary observation Fang Fang, Liu Shuangping,Wang Xiaojuan, Lin Xiaolong Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai，200011 [Abstract] Objectives: To evaluate the clinical outcomes of classified conservation treatment of adenomyosis using combined levonorgestrel-releasing intrauterine system (LNG-IUS) with gonadotropin-releasing hormone agonist (GnRHa),. Methods: Using combined LNG-IUS with GnRHa, classified treatments were applied for 92 patients suffered from adenomyosis with 3 degrees enlarged uterus. Effects on reducing the uterine volume, alleviating dysmenorrheal and lowering blood level of CA125 were observed for 36 months follow-up. Results: Treating the patients with average diameters of uterus less than 65mm, LNG-IUS solely or combined with GnRHa both can alleviate and lasts more than 36 months, and reduce the volume of uterus for 24 months. For the patients with average diameters of uterus within the range of 65mm~85mm, treating with GnRHa for 3 cycles stepped by LNG-IUS can reduce the uterine volume with 1 month and last for 12 months, while dysmenorrhea can be alleviated for 36 months. For those patients with with average diameters of uterus more than 85mm, 6 cycles of GnRHa stepped by LNG-IUS can also rapidly alleviate dysmenor