左炔诺孕酮宫内缓释系统用于预防并存卵巢子宫内膜异位囊肿和弥漫性子宫腺肌病患者保守手术后复发：一项长期随访的回顾性病例对照研究。

The role of levonorgestrel-releasing intrauterine system for recurrence prevention after conservative surgery among patients with coexistent ovarian endometrioma and diffuse adenomyosis: A retrospective case control study with long-term follow up.

机构信息

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.

Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China, Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.

出版信息

J Gynecol Obstet Hum Reprod. 2023 May;52(5):102572. doi: 10.1016/j.jogoh.2023.102572. Epub 2023 Mar 11.

DOI:10.1016/j.jogoh.2023.102572

PMID:36914113

Abstract

BACKGROUND

When ovarian endometrioma coexist with adenomyosis, the risk of postoperative recurrence increased. How is the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on symptomatic recurrence for those patients was unknown.

METHODS

This study retrospectively analyzed 119 women with coexistent endometrioma and diffuse adenomyosis who received laparoscopic excision of pelvic endometriosis from January 2009 to April 2013. Women were categorized into two groups: intervention group with LNG-IUS and control group with expectant observation after surgery. Data were compared in terms of preoperative history, laboratory and intraoperative findings, and clinical outcomes during follow-up, including pain regression, changes in uterine volume and recurrence.

RESULTS

During a median 79 months (range, 6-107) of follow-up, patients with LNG-IUS experienced a significantly lower symptomatic recurrence of either ovarian endometrioma or dysmenorrhea (11.1% vs. 31.1%, p = 0.013), compared with women under expectant observation by Kaplan-Meier survival analysis (χ = 5.448, p = 0.020) and Cox univariate assessment (hazard ratio of 0.336, 95% confidence interval 0.128-0.885, p = 0.027). Patients treated with LNG-IUS demonstrated a more prominent reduction in uterine volume (-14.1 ± 20.9 vs. 8.7 ± 48.8, p = 0.003) and higher percentage of complete pain remission (95.6% vs. 86.5%). For multivariate analysis, use of LNG-IUS (aHR 0.159, 95%CI 0.033-0.760, p = 0.021) and severity of dysmenorrhea (aHR 4.238, 95%CI 1.191-15.082, p = 0.026) were two independent factors associated with overall recurrence.

CONCLUSION

Postoperative insertion of LNG-IUS may prevent recurrence in symptomatic women with comorbidity of ovarian endometrioma and diffuse adenomyosis.

摘要

背景

当卵巢子宫内膜异位症并存时，术后复发的风险增加。对于这些患者，左炔诺孕酮宫内释放系统（LNG-IUS）对症状性复发的效果尚不清楚。

方法

本研究回顾性分析了 2009 年 1 月至 2013 年 4 月期间接受腹腔镜盆腔子宫内膜异位症切除术的 119 例卵巢子宫内膜异位症和弥漫性子宫腺肌病并存的女性。女性分为两组：干预组使用 LNG-IUS，术后观察组期待观察。比较两组术前病史、实验室和术中检查以及随访期间的临床结果，包括疼痛缓解、子宫体积变化和复发。

结果

在中位 79 个月（范围 6-107）的随访期间，与观察组相比，LNG-IUS 组患者的卵巢子宫内膜异位症或痛经症状性复发率明显较低（11.1%比 31.1%，p=0.013），通过 Kaplan-Meier 生存分析（χ²=5.448，p=0.020）和 Cox 单因素评估（风险比 0.336，95%置信区间 0.128-0.885，p=0.027）。LNG-IUS 治疗组患者的子宫体积减小更为明显（-14.1±20.9 比 8.7±48.8，p=0.003），完全缓解疼痛的比例更高（95.6%比 86.5%）。多因素分析显示，LNG-IUS 的使用（aHR 0.159，95%CI 0.033-0.760，p=0.021）和痛经严重程度（aHR 4.238，95%CI 1.191-15.082，p=0.026）是与总体复发相关的两个独立因素。