本文選題：子宮腺肌病 + 左炔諾孕酮宮內緩釋系統　； 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：目的:子宮腺肌病是婦科的常見疾病。近年來發(fā)病率呈上升趨勢,且發(fā)病人群逐漸趨于年輕化。子宮腺肌病的臨床表現主要為繼發(fā)性痛經呈進行性加重,可伴月經過多,已嚴重影響育齡婦女生活質量。藥物治療有假絕經療法和假孕療法,均可使子宮內膜萎縮,改善癥狀。但是藥物治療存在較多副反應,患者往往難以堅持使用,依從性較差。因此患者在藥物治療無效情況下多進行子宮切除術。手術治療雖然療效顯著,但是亦存在相應的手術風險及卵巢血供減少進而影響卵巢功能等并發(fā)癥。故此選擇一種既副作用少又創(chuàng)傷小的治療方法變得十分重要。左炔諾孕酮宮內緩釋系統(Levonorgestrel-releasing intrauterine system,LNG-IUS,商品名:曼月樂)可以在5年的有效期內向宮腔恒定地釋放左炔諾孕酮(levonorgestrel,LNG),對子宮腺肌病有持續(xù)治療的作用。本文對曼月樂治療子宮腺肌病的療效、不良反應及滿意度方面進行觀察研究,以指導臨床。方法:本文選擇2013年1月至2014年6月來我院婦科門診就診的46例子宮腺肌病患者。痛經程度采用視覺模擬評分法(Visual analogue scale,VAS)評估,月經血量采用月經失血圖(pictorial blood loss assessment chart,PBAC)評估,刺激性、壓力性及梗阻性的尿路癥狀采用泌尿生殖影響量表(Urinary distress inventory 6,UDI-6)評估。觀察患者放置曼月樂第3、6個月的VAS、PBAC、HGB、CA125、UDI-6變化,以及出現的不良反應和使用的滿意度。采用SPSS19.0統計學軟件對資料進行正態(tài)性檢驗,滿足正態(tài)性的采用t檢驗,各組數據用?x±s表示;不滿足正態(tài)性的采用非參數Wilcoxon秩和檢驗,數據用中位數M(P25,P75)的形式表示。以P0.05為差異有統計學意義。結果:46例患者中1名患者失訪,1名患者因曼月樂放置2周后脫落而行藥物治療,1名患者因上環(huán)2個月后月經量及貧血程度未見明顯改善而行手術治療。4名患者出現環(huán)下移再次重新放置,共有43名患者完成為期6個月的隨訪觀察。1痛經情況:患者放置曼月樂后癥狀有明顯緩解,對放置前與放置后第3、6個月的VAS評分進行分析,由放置前2(2,3)分別降為0(0,1)、0(0,0),差異均有統計學意義(P均0.01)。痛經緩解率及治愈率:①放置后3個月有42例患者痛經癥狀明顯緩解,即痛經緩解率為97.67%(42/43),其中有22例患者痛經癥狀完全消失,治愈率為51.16%(22/43);②放置后6個月43例患者痛經癥狀均有緩解,即痛經緩解率為100%,其中76.74%(33/43)患者痛經癥狀完全消失。2月經量(PBAC)評分及血紅蛋白含量(HGB):放置曼月樂前月經量PBAC評分為216.70±47.10,放置曼月樂后第3、6個月的PBAC評分分別降至74.63±16.38,49.26±22.27,差異均有統計學意義(P0.01)。放置前18例貧血患者的HGB為109.80±6.23g/L,放置后第3、6個月HGB分別為118.70±6.94g/L和126.14±6.65g/L,與放置前相比差異有統計學意義(P0.01)。3血清CA125:放置前為65.35±11.37U/ml,放置后第3、6個月時分別降為54.21±9.44U/ml和47.04±8.19U/ml,差異與放置前相比,均有統計學意義(P0.01)。4 UDI-6評分:放置曼月樂后6個月,15例患者在刺激性、壓力性和梗阻性尿路評分上的改善率分別為26.67%,13.33%,20.00%。刺激癥狀及總尿路評分有顯著差異,P值0.05。5不良反應及滿意度:陰道點滴出血是最主要的不良反應。在隨訪期間共有18例(41.86%)患者出現經間期陰道點滴出血。有4例(9.3%)患者放置后6個月出現閉經。有4例放置曼月樂后發(fā)現環(huán)位置下移,1例出現脫環(huán)。有2例(4.65%)患者出現單側卵巢囊腫。有2例(4.65%)患者在隨訪至3個月時出現行經期間乳房脹痛。有1例(2.32%)患者隨訪至5個月時出現面部痤瘡�；颊邼M意度較高,表示不滿意的患者占4.65%。結論:曼月樂治療子宮腺肌病雖然存在相應的副反應,但是療效顯著,患者滿意度較高。
[Abstract]:Objective: adenomyosis is a common disease of gynecology. In recent years the incidence of adenomyosis is rising, and the incidence of the disease is gradually becoming younger. The clinical manifestations of adenomyosis are secondary dysmenorrhea, which can be accompanied by excessive menstruation, which have seriously affected the quality of life of women of childbearing age. There are false menopause and pseudo pregnancy therapy in the treatment of drugs. It can make the endometrium atrophy and improve the symptoms. But there are many side effects in the drug treatment, and the patient is often difficult to adhere to, and the compliance is poor. Therefore, the patient has more hysterectomy under the condition of ineffective drug treatment. Although the surgical treatment is effective, there are corresponding surgical risks and the decrease of the ovarian blood supply and then the ovary. It is important to choose a treatment with less side effects and less trauma. Levonorgestrel-releasing intrauterine system (LNG-IUS system) can release levonorgestrel (levonorgestrel, LNG) continuously to the uterine cavity in the period of 5 years of validity. The effect, adverse reaction and satisfaction of the patients with adenomyosis in the treatment of uterine adenomyosis were observed and studied to guide the clinical. Methods: 46 cases of adenomyosis in gynecologic outpatient of our hospital from January 2013 to June 2014 were selected. The degree of dysmenorrhea was evaluated by visual analogue scale (Visual Analogue scale, VAS) evaluation of menstrual blood volume (Pictorial blood loss assessment chart, PBAC) assessment, irritant, stressful, and obstructive urinary tract symptoms (Urinary distress inventory 6) assessment. SPSS19.0 statistics software is used to test the data in normality to satisfy the normality by using t test. The data of each group is represented by X + s; the non parametric Wilcoxon rank sum test is adopted and the data is expressed in the form of the median M (P25, P75). Results: of the 46 patients, 1 of the 46 patients were lost and 1 patients were treated with malanle 2 weeks later. 1 patients underwent surgical treatment for 2 months after the upper ring and no significant improvement in the degree of anemia. A total of 43 patients underwent a 6 month follow-up of 6 months of follow-up. After placement, the symptoms of the patients were significantly relieved, and the VAS scores before and after the placement of the 3,6 month were analyzed, which were reduced to 0 (0,1) and 0 (0,0) before placement 2 (2,3). The difference was statistically significant (P 0.01). The remission rate and cure rate of the dysmenorrhea were: (1) 42 cases of dysmenorrhea symptoms were significantly relieved in 3 months after placement, that is, the pain of dysmenorrhea. The rate of solution was 97.67% (42/43), of which 22 cases disappeared completely and the cure rate was 51.16% (22/43). 43 cases of dysmenorrhea were relieved in 6 months after placement, that is, the remission rate of dysmenorrhea was 100%, of which 76.74% (33/43) patients completely disappeared.2 menstrual volume (PBAC) score and hemoglobin content (HGB): pre Meno meniera menorrhagia was placed. The score of PBAC was 216.70 + 47.10. The PBAC score of 3,6 months after placement was 74.63 + 16.38,49.26 + 22.27 respectively. The difference was statistically significant (P0.01). The HGB of 18 patients with anemia before placement was 109.80 + 6.23g/L, and the HGB was 118.70 + 6.94g/L and 126.14 + 6.65g/L after placement, and the difference was statistically significant compared with that before placement. The serum CA125: of.3 was 65.35 + 11.37U/ml before placement, and decreased to 54.21 + 9.44U/ml and 47.04 + 8.19U/ml at 3,6 months after placement. The difference was statistically significant (P0.01).4 UDI-6 score compared with that before placement: 6 months after placement, 15 patients were improved on the irritant, stressful and obstructive urinary tract scores. There was a significant difference between 26.67%, 13.33%, 20.00%. irritation symptoms and total urinary tract scores, P value 0.05.5 adverse reactions and satisfaction: vaginal drip bleeding was the most important adverse reaction. During the follow-up period, 18 cases (41.86%) had intermenstrual vaginal bleeding. 4 cases (9.3%) had amenorrhea 6 months after placement. 4 cases were placed in menopause. 1 cases of unilateral ovarian cysts were found in 2 cases (4.65%). 2 patients (4.65%) had menstrual swelling pain during the follow-up to 3 months. There were 1 (2.32%) patients who were followed up to 5 months to face acne. The patients were satisfied with the 4.65%. conclusion: the patients who were dissatisfied accounted for the treatment of the moon. Although adenomyosis has corresponding side effects, the curative effect is significant and patient satisfaction is high.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R711.71

【引證文獻】

相關期刊論文 前1條

1 李艷麗;;左炔諾孕酮宮內釋放系統治療子宮腺肌病痛經的療效觀察[J];實用婦科內分泌雜志(電子版);2016年07期

相關碩士學位論文 前1條

1 馮丹;左炔諾孕酮宮內緩釋系統治療子宮腺肌病的臨床研究[D];延邊大學;2016年

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本文編號：1869388