Li Qiuju, Yuan Ming, Li Ni, Zhen Qianwei, Chen Chang, Wang Guoyun
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China.
J Obstet Gynaecol Res. 2020 Oct;46(10):2092-2099. doi: 10.1111/jog.14376. Epub 2020 Jul 28.
To compare the efficacy of gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-a + levonorgestrel-releasing intrauterine system (LNG-IUS) after adenomyomectomy for improved adenomyosis-associated symptoms.
Overall, 193 patients with adenomyosis included in this study were categorized into three groups: adenomyomectomy (n = 57, group 1), adenomyomectomy + GnRH-a (n = 83, group 2) and adenomyomectomy + GnRH-a + LNG-IUS (n = 53, group 3). Visual Analog Scale (VAS) scores and uterine volumes were determined to evaluate the severity of adenomyosis. Dysmenorrhea improvement and uterine volume were the main outcomes.
The VAS scores of all patients reduced from 7.3 (6.0, 8.5) to 0 (0, 0.6) at the 6 months after surgery, which were significantly higher in group 1 compared to other groups (P < 0.05). In groups 1, 2 and 3, there were 14, 7 and 4 patients, respectively, who suffered dysmenorrhea recurrence. The mean recurrent-free-survival (RFS) was 51.6 ± 2.4, 58.0 ± 1.2 and 58.3 ± 1.0 months, respectively, which was significantly shorter in group 1 (P < 0.05). The dysmenorrhea recurrences were 26.3%, 6.1%, 5.9% in groups 1, 2 and 3, respectively, at the 36 months, which was significantly higher in group 1 (P < 0.01). Significantly decreased uterine volumes were observed in all patients from 222.2 (147.6, 350.4) to 77.0 (65.9, 94.1) mL (P < 0.05) at the 6 month after surgery.
Treatment GnRH-a and LNG-IUS after surgery could significantly reduce the recurrence and prolong the RFS. It seemed that the use of LNG-IUS was beneficial for a lower recurrence in long-term follow-up.
比较子宫腺肌病病灶切除术（腺肌肌瘤切除术）后使用促性腺激素释放激素激动剂（GnRH-a）和GnRH-a联合左炔诺孕酮宫内节育系统（LNG-IUS）改善子宫腺肌病相关症状的疗效。
本研究纳入的193例子宫腺肌病患者分为三组：腺肌肌瘤切除术组（n = 57，第1组）、腺肌肌瘤切除术+GnRH-a组（n = 83，第2组）和腺肌肌瘤切除术+GnRH-a+LNG-IUS组（n = 53，第3组）。采用视觉模拟评分法（VAS）评分和测量子宫体积来评估子宫腺肌病的严重程度。痛经改善情况和子宫体积是主要观察指标。
所有患者术后6个月时VAS评分从7.3（6.0，8.5）降至0（0，0.6），第1组的评分显著高于其他组（P < 0.05）。第1、2、3组分别有14、7和4例患者痛经复发。平均无复发生存期（RFS）分别为51.6±2.4、58.0±1.2和58.3±1.0个月，第1组明显较短（P < 0.05）。在36个月时，第1、2、3组的痛经复发率分别为26.3%、6.1%、5.9%，第1组显著更高（P < 0.01）。所有患者术后6个月时子宫体积从222.2（147.6，350.4）mL显著减小至77.0（65.9，94.1）mL（P < 0.05）。
术后使用GnRH-a和LNG-IUS治疗可显著降低复发率并延长无复发生存期。长期随访显示，使用LNG-IUS似乎有利于降低复发率。
