摘要
目的 探讨左炔诺孕酮宫内缓释系统（LNG-IUS）和复方口服避孕药（COC）用于卵巢子宫内膜异位症患者复发后治疗的评价.方法 选择因卵巢子宫内膜异位症行保守性手术或保守性手术联合药物巩固治疗后复发而就诊的患者48例,随机分为放置LNG-IUS治疗组和口服COC治疗组.于治疗后6、12、18、24个月随访,观察治疗前后患者卵巢子宫内膜异位囊肿体积的变化、疼痛视觉模拟评分、血清CA125水平,以及月经模式、体重、血脂等指标.结果 （1）放置LNG-IUS后18个月随访,2例卵巢异位囊肿消失,24个月18例卵巢异位病灶消失,异位囊肿体积由放置前（9.2±3.0）cm3缩小至（0.9±1.5）cm3,（P＜0.01＝;服用COC 24个月,12例卵巢异位病灶消失,异位囊肿体积由放置前（9.4±2.2）cm3缩小至（2.9±3.1）cm3,（P＜0.01＝;18、24个月LNG-IUS组囊肿体积缩小优于COC组,分别为（2.4±1.5）cm3vs（4.7±2.6）cm3,（P＜0.01＝;（0.9±1.5）cm3 vs（2.9±3.1）cm3,（P＜0.05＝;（2）放置LNG-IUS和服用COC后6～12个月,痛经、慢性盆腔痛或性交痛均有缓解,VAS评分与治疗前比较差异有统计学意义（P＜0.01＝;（3）放置LNG-IUS和服用COC后6个月血清CA125开始显著下降,与治疗前比较差异有统计学意义（P＜0.01＝;（4）放置LNG-IUS后6个月内不规则出血或点滴出血是常见现象,随着放置时间延长,情况明显缓解.体重增加和对脂代谢的影响是COC的主要副反应.结论 卵巢子宫内膜异位症保守性手术或手术＋药物巩固治疗后复发的患者,应用LNG-IUS或COC可有效控制或缩小卵巢子宫内膜异位囊肿,缓解疼痛,降低CA125值,其中LNG-IUS具有方便、全身副作用少的优势.
Objective To evaluate and compare the efficiency and safety of levonorgestrel-releasing intrauterine system （LNG-IUS） and combined oral contraceptives （ COC ） in the treatment of recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy. Methods A total of 48 patients with recurrent ovarian endometriosis underwent randomization. The regimens of LNG-IUS （n = 24） and COC. （ n = 24） were offered. The volume of ovarian endometriotic cysts was recorded before treatment and at 6, 12, 18 and 24 months. The volume of ovarian endometriotic cysts, pain score of visual analogue scale （VAS）, menstrual pattern, body weight, serum CA125 and serum lipids were compared to the pretreatment level within each treatment group, as well as between two treatment groups during the same period. Results （1） At 18 months after LNG-IUS, the cysts in 2 subjects entirely disappeared. At 24months, 18 patients had a disappearance of cysts. The overall size reduction was statistically significant （9. 2 ± 3.0） vs （0. 9 ± 1.5） cm3 （ P ＜ 0. 01 ＝. In the COC group, 12 subjects had a complete resolution of cysts at 24 months. The overall size reduction was statistically significant （9.4 ±2. 2） vs （2. 9 ±3. 1 ）cm3 （P＜0.01＝.At 18＆24 months, the cyst size reduction was significantly larger in the LNG-INS group than （ P ＜0. 01 ＝. At 18 the COC group （2.4±1.5） vs （4.7±2.6） cm3（P＜0.01＝ and （0.9±1.5） vs （2.9±3.1） cm3（P＜0. 05＝; （2） There was a significant improvement of dysmenorrhea, chronic pelvic pain and dyspareunia at 6- ＆ 12-month follow-up in both groups; （3） serum CA125 decreased at 6 ＆ 12 months in both groups with statistical significance. It decreased more sharply in the LNG-IUS group and remained at low levels beyond 12months; （4） within 6 months of LNS-IUS, irregular bleeding and spotting were the major side effects. Beyond that period the symptoms were significantly relieved. Weight gain and dyslipidemia were the major side effects of COC. Conclusion For patients with recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy, LNG-IUS and COC may be used to control and reduce endometriotic cysts, relieve pain and reduce the level of CA125. LNG-IUS has the advantages of a greater convenience and minor systemic side effects.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第15期1047-1050,共4页
National Medical Journal of China
