Lin Ching-Jung, Hsu Teh-Fu, Chang Yen-Hou, Huang Ben-Shian, Jiang Ling-Yu, Wang Peng-Hui, Chen Yi-Jen
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2018 Feb;57(1):47-51. doi: 10.1016/j.tjog.2017.12.036.
To evaluate whether a maintenance levonorgestrel-releasing intrauterine system is effective for preventing the recurrence of postoperative adenomyosis-related symptoms.
From January 2005 through December 2014, a retrospective study including 133 patients with symptomatic adenomyosis undergoing conservative uterine-sparing surgery followed by gonadotropin-releasing hormone agonist treatment was conducted. We excluded the 18 patients who did not meet the inclusion criteria. The patients of intervention group (n = 54) received a levonorgestrel-releasing intrauterine system (LNG-IUS), which was inserted after surgery. The patients without LNG-IUS insertion were enrolled in the control group (n = 61). The primary outcome was improvement of adenomyosis-related dysmenorrhea, which was evaluated by the visual analog scale (VAS) and by hemoglobin (Hgb) and CA-125 levels.
Over a 12-month follow-up, the intervention group exhibited a greater reduction in dysmenorrhea as assessed with a VAS score (mean ± SD: 6.5 ± 2.5 vs 4.1 ± 3.6, p = 0.001) and a greater elevation in the Hgb level (2.1 ± 1.9 vs 1.0 ± 1.7, p = 0.008) than the control group. At the end of the 24-month follow-up period, the intervention group also exhibited a greater reduction in dysmenorrhea as assessed with a VAS score (mean ± SD 6.1 ± 2.7 vs 3.7 ± 3.7, p = 0.002) and a greater elevation in the Hgb level (1.9 ± 2.1 vs 0.7 ± 1.8, p = 0.022) than the control group. The CA-125 level was significantly lower in the intervention group during the postoperative follow up (12th month follow-up, intervention vs control, 24.5 ± 28.8 vs 50.1 ± 44.0, p = 0.005; 24th month follow-up, 28.6 ± 26.2 vs 75.4 ± 68.5, p = 0.002).
The maintenance therapy of LNG-IUS is effective and well accepted for long-term therapy after conservative surgery for patients with adenomyosis.
评估左炔诺孕酮宫内缓释系统对预防术后子宫腺肌病相关症状复发是否有效。
对2005年1月至2014年12月期间133例有症状的子宫腺肌病患者进行回顾性研究，这些患者接受了保留子宫的保守手术，随后接受促性腺激素释放激素激动剂治疗。我们排除了18例不符合纳入标准的患者。干预组（n = 54）患者在术后放置左炔诺孕酮宫内缓释系统（LNG-IUS）。未放置LNG-IUS的患者纳入对照组（n = 61）。主要结局是子宫腺肌病相关痛经的改善情况，通过视觉模拟评分法（VAS）以及血红蛋白（Hgb）和CA-125水平进行评估。
在12个月的随访中，干预组经VAS评分评估的痛经减轻程度更大（均值±标准差：6.5±2.5 vs 4.1±3.6，p = 0.001），Hgb水平升高幅度更大（2.1±1.9 vs 1.0±1.7，p = 0.008），均优于对照组。在24个月随访期末，干预组经VAS评分评估的痛经减轻程度仍更大（均值±标准差6.1±2.7 vs 3.7±3.7，p = 0.002），Hgb水平升高幅度也更大（1.9±2.1 vs 0.7±1.8，p = 0.022），同样优于对照组。术后随访期间干预组的CA-125水平显著更低（第12个月随访，干预组vs对照组，24.5±28.8 vs 50.1±44.0，p = 0.005；第24个月随访，28.6±26.2 vs 75.4±68.5，p = 0.002）。
对于子宫腺肌病患者，保守手术后LNG-IUS维持治疗有效且患者接受度良好，可用于长期治疗。
