本文選題：左炔諾孕酮宮內(nèi)緩釋系統(tǒng) + 子宮腺肌病　； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的: 觀測左炔諾孕酮宮內(nèi)緩釋系統(tǒng)（LNG-IUS，曼月樂）在非避孕作用方面的臨床療效，并為子宮腺肌病、功能失調(diào)性子宮出血（主要為單純型及復(fù)雜型子宮內(nèi)膜增生）的患者，提供新的治療思路。 材料與方法: 本文選擇2012年9月～2014年1月期間在吉林大學(xué)第二醫(yī)院婦產(chǎn)科就診，要求治病非避孕因素于門診手術(shù)室擱置LNG-IUS的婦女47例。其中，根據(jù)臨床癥狀、婦科檢查及彩色多普勒超聲診斷為子宮腺肌病的患者29例；排除外生殖器及全身器質(zhì)性病變后診斷為功血的患者18例，其中子宮內(nèi)膜單純型增生4例，復(fù)雜型增生2例。應(yīng)用自身配對t檢驗(yàn)，子宮腺肌病的患者觀察放置LNG-IUS前及放置后第3,6,12個月的月經(jīng)量改變（PBAC評分）、痛經(jīng)緩解程度（口述描述評分法VRS）、子宮體積大小變化、血紅蛋白含量變化；功血的患者觀測放LNG-IUS前及放置后第3,6,12個月的月經(jīng)改變（包括月經(jīng)量、月經(jīng)周期及經(jīng)期），以及子宮內(nèi)膜厚度(經(jīng)陰道婦科彩色多普勒超聲所測得的子宮內(nèi)膜雙層厚度)，6例子宮內(nèi)膜增生的患者，，放置6個月后再次行刮宮，觀察病理類型轉(zhuǎn)歸情況。另外，觀察47例病人放入LNG-IUS后第3,6,12個月陰道不規(guī)則出血、下腹痛或腰痛、體重增加等副反應(yīng)情況。 結(jié)果: 1、29例因子宮腺肌病放入LNG-IUS的患者中脫環(huán)或要求取環(huán)共4例，其中1例重新置入后未再脫落，另3例退出研究組。余下的26例患者中，放置LNG-IUS后第3，6,12個月與放置前相比，其PBAC評分及痛經(jīng)VRS評分均明顯降低，差異均有統(tǒng)計學(xué)意義(P0.01)。血紅蛋白含量（g/l），放置LNG-IUS后第3，6,12個月與放置前相比也均明顯上升，差異均有統(tǒng)計學(xué)意義(P0.05)。在放入后第3，6個月時子宮體積大�。╟m3）較前略有減小，但差異無統(tǒng)計學(xué)意義；放入后第12個月時由放前的306.20±75.56降至230.60±49.93，差異有統(tǒng)計學(xué)意義（P0.05）。 2、18例功血放置LNG-IUS的患者中，除有1例因置環(huán)2個月時隨月經(jīng)血脫落，且因出血量較多造成暈厥立即行手術(shù)治療退出研究組外，其余的17例患者中，置環(huán)3個月后月經(jīng)量PBAC評分、內(nèi)膜厚度（mm）分別由127.20±18.94、14.20±3.49降至107.00±14.40、9.60±2.19，差異有統(tǒng)計學(xué)意義（P0.01）；放置12個月后經(jīng)期（天）為4.20±1.48，與放置前6.00±1.58相比，經(jīng)期明顯縮短，有統(tǒng)計學(xué)意義(P0.01)。置環(huán)前后月經(jīng)周期略有變化，但差異無統(tǒng)計學(xué)意義。另外，6例子宮內(nèi)膜增生的患者，置環(huán)6個月后再次行刮宮送病理，結(jié)果提示單純型及復(fù)雜型內(nèi)膜增生改變?nèi)肯В瑑?nèi)膜間質(zhì)呈蛻膜樣變。大部分宮內(nèi)膜腺體呈分泌反應(yīng)，部分腺體萎縮，無異型性。 3、放置LNG-IUS后主要的不良反應(yīng)包括不規(guī)則陰道出血、下腹部或腰部疼痛、脫環(huán)或環(huán)下移、卵巢囊腫，少數(shù)患者可出現(xiàn)月經(jīng)稀發(fā)、甚至閉經(jīng)，個別患者出現(xiàn)體重增加、痤瘡、面部色素沉著、乳房發(fā)脹等內(nèi)分泌癥狀。 結(jié)論: 應(yīng)用LNG-IUS對于子宮腺肌病的患者，可明顯緩解痛經(jīng)、減少經(jīng)血、縮小子宮體積、增加血紅蛋白含量；對于功能失調(diào)性子宮出血的患者，在減少月經(jīng)量的同時，使子宮內(nèi)膜厚度明顯變薄，經(jīng)期隨著放置時間的延長也逐漸縮短，子宮內(nèi)膜增生型病變得以治愈，不但降低了手術(shù)率，而且保留了生育功能，是一種安全、有效、便捷、經(jīng)濟(jì)的治療方法。同時也存在相應(yīng)的副反應(yīng)，如不規(guī)則陰道出血、下腹部或腰部疼痛、脫環(huán)、閉經(jīng)及內(nèi)分泌變化等。
[Abstract]:Objective:
The clinical efficacy of levonorgestrel releasing intrauterine system (LNG-IUS) in the non contraceptive effect was observed, and a new therapeutic idea was provided for the patients with uterine adenomyosis and dysfunctional uterine bleeding (mainly simple and complicated endometrial hyperplasia).
Materials and methods:
In the second hospital of Jilin University from September 2012 to January 2014, we chose 47 cases of LNG-IUS in outpatient operation room. Among them, 29 cases of adenomyosis were diagnosed according to clinical symptoms, gynecologic examination and color Doppler ultrasound, and the external genitals and systemic organic nature were excluded. 18 cases of dysfunctional uterine bleeding were diagnosed after pathological changes, including 4 cases of simple hyperplasia of endometrium and 2 cases of complex hyperplasia. The patients with uterine adenomyosis were used to observe the changes of menstrual volume (PBAC score) before and after 3,6,12 months of placement of adenomyosis (PBAC score), dysmenorrhea (oral description scoring method VRS), and the size of uterus, and the size of uterus was changed, and 18 cases of uterine adenomyosis were observed. Changes in hemoglobin content; menstrual changes before and after LNG-IUS (including menstrual volume, menstrual cycle and menstrual period), and endometrial thickness (double thickness of endometrium measured by color Doppler ultrasound of the vagina), 6 cases of endometrial hyperplasia in patients with endometrium hyperplasia, were placed again after 6 months. In addition, 47 patients with irregular vaginal bleeding, lower abdominal pain or low back pain and weight gain were observed in 47 patients after 3,6,12 months after LNG-IUS.
Result:
Of the patients with adenomyosis in 1,29, 4 cases were removed or required to take the ring in the patients with LNG-IUS, of which 1 cases were replaced and 3 cases were withdrawn from the study group. Among the remaining 26 patients, the PBAC score and the dysmenorrhea VRS score were significantly decreased in the remaining 26 months after placement of LNG-IUS, and the difference was statistically significant (P0.01). The content of erythroprotein (g/l) was significantly increased in 3,6,12 months after placement of LNG-IUS, and the difference was statistically significant (P0.05). The size of the uterus (cm3) decreased slightly at the end of 3,6 months, but the difference was not statistically significant, and the difference was reduced from 306.20 + 75.56 before twelfth months to 230.60 + 49.93. There was a statistical significance (P0.05).
Among the patients with LNG-IUS in 2,18, 1 cases were removed from the study group after 2 months of ring, and the amount of bleeding caused the syncope to quit the study group immediately. In the rest of the 17 patients, the amount of menstrual volume was PBAC score after 3 months, and the thickness of the endometrium (mm) dropped from 127.20 + 18.94,14.20 3.49 to 107 + 14.40,9.60 + 2.1. 9, the difference was statistically significant (P0.01); after 12 months, the menstrual period (day) was 4.20 + 1.48. Compared with 6 + 1.58 before placement, the menstrual period was significantly shortened and had statistical significance (P0.01). There was a slight change in the menstrual cycle before and after the insertion of the ring, but the difference was not statistically significant. In addition, the patients with endometrium hyperplasia in 6 cases were given the curettage again for 6 months. The results showed that all the hyperplasia of endometrium in simple and complex type disappeared, and the endometrium was deciduoid. Most of the endometrium glands were secreted and some glands atrophied and had no atypia.
3, the main adverse reactions after the placement of LNG-IUS include irregular vaginal bleeding, pain in the lower abdomen or waist, dering or ring down, ovarian cysts, a few patients may have menstrual dilute hair, even amenorrhea, individual patients have weight gain, acne, facial pigmentation, breast distention and other endocrine symptoms.
Conclusion:
LNG-IUS for patients with adenomyosis can obviously relieve dysmenorrhea, reduce menstrual blood, reduce the volume of uterus and increase the hemoglobin content; for patients with dysfunctional uterine bleeding, the thickness of the endometrium is obviously thinner while the menstrual volume is reduced, and the menstrual period is gradually shortened with the prolongation of the time of placement and the endometrium hyperplasia. The disease is cured. It not only reduces the rate of operation, but also preserves the fertility function. It is a safe, effective, convenient and economical treatment. It also has the corresponding side effects, such as irregular vaginal bleeding, lower abdomen or waist pain, dering, amenorrhea and internal secretion.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.52;R711.71

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