目的 探讨宫腔镜下病灶切除术联合宫腔内左炔诺孕酮释放系统(LNG-IUS)治疗内突型子宫腺肌瘤的近中期临床疗效.方法 对2014-01-01-2015-04-31期间大连医科大学附属大连市妇幼保健院18例子宫腺肌瘤患者行宫腔镜下病灶切除术联合LNG-IUS治疗,记录手术时间、术中及术后并发症情况,比较术前及术后的痛经改善情况、月经量的变化、子宫体积的变化及子宫腺肌瘤复发情况.结果 18例宫腔镜下子宫腺肌瘤病灶切除术手术时间(58.3±6.4)min,无术中、术后并发症.术后随访6～12个月.14例痛经患者,2例(2/14,l4.3％)部分缓解,5例(5/14,35.7％)明显缓解,5例(5/14,35.7％)完全缓解,2例(2/14,14.3％)无月经来潮.14例经量多者,术后经量均减少、经期缩短,且差异有统计学意义[为术前的(29.3±0.7)％,P＜ 0.05];月经周期术前术后差异无统计学意义[(7.8±3.3)d vs.(4.3±2.2)d,P＞0.05].10例合并不同程度贫血者贫血均纠正.术后6个月子宫体积均缩小,且差异有统计学意义[(232.5±94.5) cm3 vs.(123.8±59.4)cm3,P＜0.05],随访期间彩超均未提示子宫腺肌瘤复发.8例(8/18)术后阴道分泌物量多、稀薄;4例(4/18)术后3个月内有点滴阴道流血,均于3～6个月渐恢复正常;1例(1/18)体重增加.2例(2/18)因阴道分泌物较多表示满意度欠佳,余均满意.结论 宫腔镜下子宫腺肌瘤病灶切除术联合LNG-IUS治疗内突型子宫腺肌瘤近中期疗效明显.%Objective To study the short-term clinical curative effect of hysteroscopic resection combined with LNG-IUS treatment for uterine adenomyona.Methods Eighteen cases of uterine adenomyoma who underwent hysteroscopic resection combined with LNG-IUS treatment from January 1,2014 to April 31,2015 in Dalian Maternity Hospital Affiliated to Dalian Medical University were selected.The operation time,intraoperative and postoperative complications were recorded;the improvement of dysmenorrhea,the changes of menstrual volume and uterine volume and the relapse of uterine adenomyoma were compared before and after surgery.Results In 18 cases,the operation time was(58.3±6.4)min,and there was no intraoperative or postoperative complications.Postoperative follow-up lasted for 6-12 months;in 14 cases of dysmenorrhea,2 (2/14,14.3％)cases had partial remission,5 (5/14,35.7％)cases were greatly relieved,and 5 (5/ 14,35.7％)cases had complete remission,while 2(2/14,14.3％)cases had no menstruation.In 14 cases of menorrhagia,the volume was reduced and the period was shortened after the surgery,the difference being statistically significant (P ＜ 0.05).There was no significant difference in the postoperative period of the menstrual cycle (P ＞ 0.05).The anemia were corrected in 10 cases with different degree of anemia.The uterine volume were reduced in 6 months after the operation,the difference being statistically significant(P ＜ 0.05);follow-up ultrasonography showed no recurrence of uterine adenomyoma.In 8 patients (8/18),the amount of vaginal discharge was more than before surgery;four cases (4/18)had a bit of vaginal bleeding within 3 months after the surgery,which recovered to normal in 3-6 months;1 patient (1/18)had weight increase;2 patients were unsatisfied because of much vaginal discharge,and the rest were satisfied.Conclusion The short-term curative effect of hysteroscopic resection combined with LNG-IUS treatment is significant in the treatment of uterine adenomyoma.
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