目的 观察性研究左炔诺孕酮宫内缓释器(曼月乐)在子宫内膜增生治疗中的作用.方法 收集2006年1月至2013年12月就诊于北京协和医院、使用曼月乐治疗子宫内膜增生的患者共42例,进行临床资料研究并进行随访.观察主要指标是上环后临床症状(阴道出血量)改善程度,以及带环3个月、6个月以及16个月子宫内膜病理逆转情况.结果 曼月乐治疗子宫内膜增生病例共42例,其中子宫内膜增生不伴非典型性(EH)患者27例,子宫内膜不典型增生(AEH/EIN)患者15例.EH患者治疗前均有阴道出血多于月经1倍以上的症状,治疗后症状改善率为81.4%;而AEH/EIN患者治疗前有2例是因不育行诊刮时发现内膜病变,并无阴道出血增多症状,另13例患者症状改善率为84.6%,与EH患者比较,两者无显著性差异(P>0.05).所有中、重度AEH/EIN患者阴道出血多的症状全部得到改善.轻、中、重度AEH/EIN患者在随访3个月时病理逆转比例为50%、33.3%及67%;随访6个月时为75%、100%及67%;随访至16个月时,中、重度AEH/EIN全部病理逆转,而有一例轻度AEH/EIN患者病变持续,无一例病情进展患者.结论 曼月乐环能改善子宫内膜增生患者阴道出血多的症状,使AEH/EIN患者内膜得到逆转,是除手术及口服药物以外治疗子宫内膜增生的另一可靠选择.%Objective:To evaluate the potential treatment effect of levonorgestrel intrauterine system (LNG-IUS) on atypical and non-atypical endometrial hyperplasia.Methods:A prospective observational study was undertaken in Peking Union Medical College Hospital from 2006 to 2013.The women with abnormal uterus bleeding underwent an endometrial biopsy and were followed by the insertion of a LNG-IUS.The study was comprised of 42 patients.The main observation indicators were the improvement of clinical symptoms (vaginal bleeding increased) after insertion LNG-IUS and the pathological changes of endometrium after 3,6 and 16 months of treatment.Results:Among 42 patients treated with LNG-IUS,the histology examination showed endometrial hyperplasia without atypia(EH) in 27 patients,and atypical endometrial hyperplasia (AEH/EIN)in 15 patients.These patients chose to be managed conservatively with repeat sampling of endometrium.The EH patients had vaginal bleeding with volume 1 times more than menstruation before treatment,and 81.4% of them improved symptoms after treatment.Two of AEH/EIN patients were found endometrial lesions by infertility curettage before treatments,and they had no vaginal bleeding increased symptom.The symptoms improved rate of the other 13 patients was 84.6%,which was not significantly different with the EH patients(P>0.05).The vaginal bleeding increased symptom was improved in all patients with moderate and severe AEH/EIN.The vaginal bleeding increased symptom of the patients with mild,moderate and severe AEH/EIN had 50%,33.3% and 67% reversal of pathology at 3 months of follow-up,75%,100% and 67% at 6 months respectively.All the moderate and severe AEH/EIN patients reversed pathological changes.There was one mild AEH/EIN patient's lesions persisted,but no one patient had lesion progression.Conclusions:LNG-IUS can improve the vaginal bleeding increased symptom in the patients with endometrial hyperplasia,and reverse the endometrial lesion.It is another reliable choice in addition to surgery and oral medication for treatment of endometrial hyperplasia in AEH/EIN patients.
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