本文關鍵詞： LNG-IUS GnRHa 月經過多 痛經　出處：《重慶醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的觀察左炔諾孕酮宮內緩釋系統(tǒng)(Levonorgestrel-releasing intrauterine system,LNG-IUS,商品名:曼月樂)治療經量過多和痛經的有效性,比較其單用或與促性腺激素釋放激素激動劑(Gonadotropin releasing hormone agonist,GnRHa)聯(lián)合使用的療效和副反應。方法我院2007年7月至2013年10月期間因經量過多及/或痛經,診為子宮腺肌癥(341例)、盆腔子宮內膜異位癥(68例)和功血(101例)的患者共510例選擇安置LNG-IUS作為治療手段。對這部分患者進行隨訪(3天-92月,中位隨訪時間21月)分析。結果87.4%(339/388)的經量過多者治療后經量有效減少,87.3%(377/432)合并痛經或盆腔疼痛者治療后疼痛有效緩解。510例患者中,GnRHa聯(lián)合LNG-IUS治療者87例(17.1%),單用LNG-IUS治療者423例(82.9%)。與單用相比,聯(lián)合GnRHa應用減少經量(91.8%VS.86.5%,P=0.256)、緩解腹痛(91.8%VS.86.5%,P=0.326)的療效似乎更好,但無統(tǒng)計學意義。兩組間放置LNG-IUS后的自然脫落率(9.2%VS.8.5%,P=0.836)亦無統(tǒng)計學差異,不過相對單用而言,聯(lián)合Gn RHa應用者環(huán)自然脫落時間更晚(中位脫落時間10.5月VS.3.5月,P=0.041)、被迫取出率更低(3.4%VS.12.8%,P=0.02),故患者滿意度也更高(86.2%VS.75.7%,P=0.032)。結論LNG-IUS不僅具有高效避孕的效果,還能有效減少月經量、緩解痛經和慢性盆腔痛。聯(lián)合Gn RHa/LNG-IUS與單用LNG-IUS相比,療效沒有顯著優(yōu)勢,不過聯(lián)合應用者LNG-IUS脫落時間更晚、被迫取出率更低、滿意度更高。
[Abstract]:Objective to observe the efficacy of Levonorgestrel-releasing intrauterine system LNG-IUSS (trade name: Manyue) in the treatment of menstrual overdose and dysmenorrhea. The efficacy and side effects of gonadotropin releasing hormone agonist GnRHawere compared with those of gonadotropin releasing agonist GnRHa.Methods from July 2007 to October 2013, our hospital suffered from excessive menstrual volume and / or dysmenorrhea. A total of 510 cases of adenomyosis, 68 cases of endometriosis and 101 cases of dysplasia) were treated with LNG-IUS. The patients were followed up for 3 days to 92 months. Analysis of median follow-up time (21 months). Results 87.4% of the patients with overdose (87.4% 339 / 388) were significantly reduced after treatment. (87.3% 377 / 432) pain relief after treatment with dysmenorrhea or pelvic pain. 87 cases were treated with GnRHa combined with LNG-IUS. 87 cases were treated with LNG-IUS alone. Of the 423 cases, 82.9%. Compared with the single use, The combination of GnRHa and VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5VS.86.5P0.836between the two groups seems to be better, but there is no statistical significance. There is no statistical difference between the two groups after placing VS.8.5P0.836), however, there is no statistical difference between the two groups in terms of the natural fall off rate of VS.8.5P0.836. In combination with Gn RHa, the natural exfoliation time of the ring was much later (median abscission time was 10.5 months, VS.3.5 month was 0.041, forced removal rate was lower than 3.4VS.12.8cm), so the patient satisfaction was also higher (86.2VS.75.7P0.032.Conclusion LNG-IUS not only has the effect of effective contraception, but also can effectively reduce the menstrual volume. Compared with LNG-IUS alone, the combination of Gn RHa/LNG-IUS had no significant effect on relieving dysmenorrhea and chronic pelvic pain. However, the patients with combined use of Gn RHa/LNG-IUS had lower rate of forced removal and higher satisfaction with LNG-IUS.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R711.71;R711.51

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