左炔诺孕酮宫内节育系统与腹腔镜子宫切除术治疗增大子宫的月经过多的比较研究。
Comparative study of the levonorgestrel intrauterine system and laparoscopic hysterectomy for the treatment of heavy menstrual bleeding in enlarged uteri.
机构信息
Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", São Paulo, SP, Brazil.
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
出版信息
Einstein (Sao Paulo). 2023 Apr 17;21:eAO0033. doi: 10.31744/einstein_journal/2023AO0033. eCollection 2023.
OBJECTIVE
The levonorgestrel intrauterine system treatment prevents 67.7% of surgeries in patients with heavy menstrual bleeding and enlarged uteri. To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy.
METHODS
This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enlarged uterus. Sixty-two women were treated and followed up for four years. Insertion of the levonorgestrel intrauterine system was performed in Group 1, and laparoscopic hysterectomy was performed in Group 2.
RESULTS
In Group 1 (n=31), 21 patients (67.7%) showed improvement in the bleeding pattern, and 11 patients (35.5%) had amenorrhea. Five patients (16.1%) remained with heavy bleeding and were considered to have experienced treatment failure. There were seven expulsions (22.6%); in five patients, bleeding remained heavy, but in two patients the bleeding returned to that of normal menstruation. No relationship was found between treatment failure and greater hysterometries (p=0.40) or greater uterine volumes (p=0.50), whereas expulsion was greater in uteri with smaller hysterometries (p=0.04). There were 13 (21%) complications, seven (53.8%) in the group that underwent insertion of the levonorgestrel intrauterine system (all were device expulsions), and six (46.2%) in the surgical group, which were the most severe ones (p=0.76). Regarding satisfaction, 12 patients (38.7%) were dissatisfied with the levonorgestrel intrauterine system and one (3.23%) was dissatisfied with the surgical treatment (p=0.00).
CONCLUSION
Treatment with the levonorgestrel intrauterine system in patients with heavy menstrual bleeding and an enlarged uterus was effective, and when compared with laparoscopic hysterectomy, it had a lower rate of satisfaction and the same rate of complications, although less severe.
目的
左炔诺孕酮宫内节育系统治疗可使 67.7%的月经过多和子宫增大患者免于手术。评估左炔诺孕酮宫内节育系统治疗月经过多和子宫增大患者的有效性，并比较其与子宫切除术的满意度及其并发症。
方法
这是一项比较性的横断面观察性研究，纳入了月经过多和子宫增大的女性患者。62 名患者接受治疗并随访 4 年。在第 1 组中插入左炔诺孕酮宫内节育系统，在第 2 组中进行腹腔镜子宫切除术。
结果
在第 1 组（n=31）中，21 名患者（67.7%）的出血模式得到改善，11 名患者（35.5%）出现闭经。5 名患者（16.1%）仍有大量出血，被认为治疗失败。有 7 例（22.6%）发生脱落；在 5 例患者中，出血仍然较多，但在 2 例患者中，出血恢复到正常月经水平。治疗失败与更大的子宫大小（p=0.40）或更大的子宫体积（p=0.50）之间无相关性，而脱落与子宫较小者更相关（p=0.04）。共有 13 例（21%）出现并发症，7 例（53.8%）发生在放置左炔诺孕酮宫内节育系统的组中（均为器械脱落），6 例（46.2%）发生在手术组，且为更严重的并发症（p=0.76）。关于满意度，12 名患者（38.7%）对左炔诺孕酮宫内节育系统不满意，1 名患者（3.23%）对手术治疗不满意（p=0.00）。
结论
左炔诺孕酮宫内节育系统治疗月经过多和子宫增大患者是有效的，与腹腔镜子宫切除术相比，其满意度较低，并发症发生率相同，但严重程度较低。
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