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目的探讨左炔诺孕酮宫内缓释系统(LNG-IUS)治疗症状性子宫腺肌病[重度痛经和(或)经量过多]过程中计划外取出和脱落的情况。方法北京协和医院妇产科2006年12月至2014年12月对超声诊断为子宫腺肌病的重度痛经和(或)经量过多患者给予LNG-IUS治疗,在放置前后评估患者的痛经症状、疼痛评分、出血评分、生化指标、体格参数、月经模式以及不良反应,分析LNG-IUS计划外取出和脱落情况及其相关因素。结果符合入选标准的病例总计1100例。LNG-IUS放置60个月的累积取出率和脱落率分别为9%和16%,66%的取出和69%的脱落发生在放置12个月以内。LNG-IUS计划外取出的常见原因是月经模式改变或不良反应(75.0%)以及感觉治疗效果不佳(55.8%)。回归分析发现,腹腔镜术中放置LNG-IUS能够降低计划外取出(OR=0.63,95%CI 0.40~0.99,P=0.040),而放置前应用促性腺激素释放激素激动剂(Gn RH-a)和经量过多的症状是放置后脱落的相关因素(OR分别为0.50和1.71,95%CI分别为0.34~0.74和1.20~2.43,P值分别为<0.001和0.003)。取出和脱落LNG-IUS与治疗结局、月经模式变化以及实际的不良反应均无显著相关。结论大部分LNG-IUS的取出和脱落情况发生在放置后12个月内。妇科腹腔镜术中放置LNG-IUS能够减少患者的计划外取出。经量过多的子宫腺肌病患者放置LNG-IUS后脱落率显著增加,放置前应用Gn RH-a可以降低脱落率。取出和脱落与治疗结局、月经模式变化以及不良反应等均无关。
Objective To investigate the effects of levonorgestrel-releasing intrauterine release system (LNG-IUS) in the treatment of symptomatic adenomyosis [severe dysmenorrhea and / or overweight] during unplanned removal and shedding. Methods The obstetrics and gynecology department of Peking Union Medical College Hospital from December 2006 to December 2014 was treated with LNG-IUS for patients with severe dysmenorrhea and / or over-diagnosed adenomyosis by ultrasonography. The dysmenorrhea symptoms were evaluated before and after the placement , Pain score, bleeding score, biochemical parameters, physical parameters, menstrual patterns and adverse reactions were analyzed. The situation of removing and shedding of LNG-IUS and its related factors were analyzed. Results A total of 1 100 cases met the inclusion criteria. The cumulative take-out and shedding rates for LNG-IUS for 60 months were 9% and 16%, respectively, with 66% removal and 69% shedding occurring within 12 months of placement. Common causes of LNG-IUS unplanned removal were menopausal patterns or adverse events (75.0%) and poor sensory response (55.8%). Regression analysis found that LNG-IUS laparoscopic surgery can reduce the unplanned removal (OR = 0.63,95% CI 0.40 to 0.99, P = 0.040), while the application of gonadotropin-releasing hormone agonist (Gn RH-a ) And those with excessive overdose were associated with shedding after placement (OR, 0.50 and 1.71, respectively; 95% CI, 0.34 to 0.74 and 1.20 to 2.43, respectively; P values <0.001 and 0.003, respectively). There was no significant correlation between LNG-IUS removal and shedding, treatment outcome, changes in menstrual patterns, and actual adverse reactions. Conclusion Most LNG-IUS removal and shedding occurred within 12 months after placement. The placement of LNG-IUS in gynecological laparoscopy can reduce the unplanned removal of patients. Excessive amount of adenomyosis patients placed LNG-IUS shedding rate increased significantly, before placing Gn RH-a can reduce shedding rate. Removal and loss and treatment outcome, changes in menstrual patterns and adverse reactions have nothing to do.