Xu Xiao-wen, Wang Le-dan, Zhu Xue-qiong, Yan Lin-zhi, Guan Yu-tao, Zhu Shi-chai, Hu Yue
Department of Obstetrics & Gynecology, Second Affiliated Hospital, Wenzhou Medical College, Wenzhou 325027, China.
Zhonghua Yi Xue Za Zhi. 2011 Apr 19;91(15):1047-50.
To evaluate and compare the efficiency and safety of levonorgestrel-releasing intrauterine system (LNG-IUS) and combined oral contraceptives (COC) in the treatment of recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy.
A total of 48 patients with recurrent ovarian endometriosis underwent randomization. The regimens of LNG-IUS (n = 24) and COC (n = 24) were offered. The volume of ovarian endometriotic cysts was recorded before treatment and at 6, 12, 18 and 24 months. The volume of ovarian endometriotic cysts, pain score of visual analogue scale (VAS), menstrual pattern, body weight, serum CA125 and serum lipids were compared to the pretreatment level within each treatment group, as well as between two treatment groups during the same period.
(1) At 18 months after LNG-IUS, the cysts in 2 subjects entirely disappeared. At 24 months, 18 patients had a disappearance of cysts. The overall size reduction was statistically significant (9.2 ± 3.0) vs (0.9 ± 1.5) cm(3) (P < 0.01). In the COC group, 12 subjects had a complete resolution of cysts at 24 months. The overall size reduction was statistically significant (9.4 ± 2.2) vs (2.9 ± 3.1) cm(3) (P < 0.01). At 18 & 24 months, the cyst size reduction was significantly larger in the LNG-INS group than the COC group (2.4 ± 1.5) vs (4.7 ± 2.6) cm(3) (P < 0.01) and (0.9 ± 1.5) vs (2.9 ± 3.1) cm(3) (P < 0.05); (2) There was a significant improvement of dysmenorrhea, chronic pelvic pain and dyspareunia at 6- & 12-month follow-up in both groups; (3) serum CA125 decreased at 6 & 12 months in both groups with statistical significance. It decreased more sharply in the LNG-IUS group and remained at low levels beyond 12 months; (4) within 6 months of LNS-IUS, irregular bleeding and spotting were the major side effects. Beyond that period the symptoms were significantly relieved. Weight gain and dyslipidemia were the major side effects of COC.
For patients with recurrent ovarian endometriosis after conservative surgery or conservative surgery plus medical therapy, LNG-IUS and COC may be used to control and reduce endometriotic cysts, relieve pain and reduce the level of CA125. LNG-IUS has the advantages of a greater convenience and minor systemic side effects.
评估和比较左炔诺孕酮宫内节育系统（LNG-IUS）与复方口服避孕药（COC）在保守手术或保守手术加药物治疗后复发性卵巢子宫内膜异位症治疗中的有效性和安全性。
共48例复发性卵巢子宫内膜异位症患者进行随机分组。分别采用LNG-IUS方案（n = 24）和COC方案（n = 24）。记录治疗前及治疗后6、12、18和24个月时卵巢子宫内膜异位囊肿的体积。比较各治疗组内治疗后与治疗前卵巢子宫内膜异位囊肿体积、视觉模拟评分法（VAS）疼痛评分、月经模式、体重、血清CA125及血脂水平，以及同期两组间上述指标的差异。
（1）LNG-IUS治疗18个月时，2例患者囊肿完全消失。24个月时，18例患者囊肿消失。总体积缩小具有统计学意义（9.2±3.0） vs （0.9±1.5）cm³（P < 0.01）。COC组24个月时12例患者囊肿完全消退。总体积缩小具有统计学意义（9.4±2.2） vs （2.9±3.1）cm³（P < 0.01）。18和24个月时，LNG-IUS组囊肿缩小幅度显著大于COC组（2.4±1.5） vs （4.7±2.6）cm³（P < 0.01）和（0.9±1.5） vs （2.9±3.1）cm³（P < 0.05）；（2）两组在随访6个月和12个月时痛经、慢性盆腔痛及性交困难均有显著改善；（3）两组血清CA125在6个月和12个月时均下降，差异有统计学意义。LNG-IUS组下降更明显，且12个月后维持在低水平；（4）LNG-IUS使用6个月内，不规则出血和点滴出血为主要副作用。此后症状显著缓解。体重增加和血脂异常为COC的主要副作用。
对于保守手术或保守手术加药物治疗后复发性卵巢子宫内膜异位症患者，LNG-IUS和COC均可用于控制和缩小子宫内膜异位囊肿、缓解疼痛及降低CA125水平。LNG-IUS具有使用更方便、全身副作用较小的优点。
