Xu Xiao-wen, Zhang Yi-wen, He Fang-fang, Wang Le-dan, Guan Yu-tao, Sun Jing, Lin Ming, Hu Yue
Department of Obstetrics and Gynecology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027, China.
Zhonghua Fu Chan Ke Za Zhi. 2011 Apr;46(4):250-4.
To evaluate the efficiency of levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment.
Twenty-three patients with recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment were treated by LNG-IUS. All patients rejected further operation and had no desire of fertility. The visual analogue scale (VAS) scores of pain, menstrual model, weight and serum CA125 level and the volume of ovarian endometriotic cysts before and after 3, 6, 12, 24 and 36 months of treatment were recorded and compared.
(1) VAS score:after 12 months of using LNG-IUS, dysmenorrheal, chronic pelvic pain or dyspareunia were relieved significantly. VAS score were dropped from 5.9±2.3, 4.3±2.0 to 1.0±0.7, 1.4±1.1 (P<0.01). (2) Volum of cysts:after 6 months of using LNG-IUS, the volume of recurrent ovarian endometriotic cysts in 11 patients were reduced from (11.4±6.1) cm3 to (5.5±3.4) cm3 significantly (P<0.01). At 12 months of follow-up, it suggested that 2 patients' ovarian endometriotic cysts disappeared. At 24 months follow-up, 9 patients ovarian endometriotic cysts disappeared (3) CA125: serum CA125 decreased from (65.5±19.6) kU/L to (42.1±13.6) kU/L at 6 months after treatment remarkably (P<0.01). Continued to decrease after 12 months and then become steady. Irregular bleeding and spotting was the main side effects, weight gain was also observed in few patients.
LNG-IUS could be used in treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment effectively. It could relieve pain, reduce the level of CA125 and decrease the size of ovarian endometriotic cysts. LNG-IUS seems to be an effective, safe, and long term treatment for endometriosis with fewer side effects and better compliance.
评估左炔诺孕酮宫内节育系统（LNG-IUS）治疗保守性手术或保守性手术联合药物治疗后复发性子宫内膜异位症的疗效。
对23例保守性手术或保守性手术联合药物治疗后复发性子宫内膜异位症患者采用LNG-IUS治疗。所有患者均拒绝进一步手术且无生育意愿。记录并比较治疗前及治疗3、6、12、24和36个月后患者的视觉模拟评分（VAS）疼痛评分、月经模式、体重、血清CA125水平以及卵巢子宫内膜异位囊肿体积。
（1）VAS评分：使用LNG-IUS 12个月后，痛经、慢性盆腔痛或性交困难明显缓解。VAS评分从5.9±2.3、4.3±2.0降至1.0±0.7、1.4±1.1（P<0.01）。（2）囊肿体积：使用LNG-IUS 6个月后，11例复发性卵巢子宫内膜异位囊肿患者的囊肿体积从（11.4±6.1）cm³显著减小至（5.5±3.4）cm³（P<0.01）。随访12个月时，2例患者的卵巢子宫内膜异位囊肿消失。随访24个月时，9例患者的卵巢子宫内膜异位囊肿消失。（3）CA125：治疗6个月后血清CA125从（65.5±19.6）kU/L显著降至（42.1±13.6）kU/L（P<0.01）。12个月后继续下降，然后趋于稳定。不规则出血和点滴出血是主要副作用，少数患者还观察到体重增加。
LNG-IUS可有效用于治疗保守性手术或保守性手术联合药物治疗后复发性子宫内膜异位症。它可缓解疼痛、降低CA125水平并减小卵巢子宫内膜异位囊肿大小。LNG-IUS似乎是一种有效、安全且长期的子宫内膜异位症治疗方法，副作用较少且依从性较好。
