Xu Pan, Ling Shanshan, Hu E, Ma Lina, Liu Jie, Yi Bixia
Department of Gynecology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China.
School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China.
Biomed Rep. 2024 Jun 4;21(1):109. doi: 10.3892/br.2024.1797. eCollection 2024 Jul.
The present study aimed to investigate the efficacy of hysteroscopic levonorgestrel-releasing intrauterine device (LNG-IUD) fixation surgery in the treatment of adenomyosis through a cohort study. The cohort study was performed at the Affiliated Jinhua Hospital of Wenzhou Medical University (Jinhua, China). A total of 31 women with adenomyosis were initially recruited from June 2020 to June 2022 and divided into an experimental group and a control group. The experimental group underwent hysteroscopic LNG-IUD fixation surgery and the control group underwent conventional implantation of the levonorgestrel-releasing intrauterine system. The assessed efficacy outcomes included the time of LNG-IUD expulsion, postoperative vaginal bleeding time, dysmenorrhea, and the menstrual blood loss score (MBLS). A total of 31 participants completed the research. The LNG-IUD expulsion rate was 6.25 and 60% (P<0.05) in the experimental and control group, respectively. The LNG-IUD in place time was 20.50 months (Q, 15.75; Q, 24.00) in the experimental group and 10.00 months (Q, 6.50; Q, 15.00) in the control group (P<0.05); the time of vaginal bleeding after surgery in the experimental and control groups were 12.50 days (9.25, 16.25) and 120.00 days (75.00, 120.00), respectively (P<0.05). Multiple-factor Cox regression analysis revealed that the LNG-IUD expulsion in patients with adenomyosis is associated with the hysteroscopic LNG-IUD fixation surgery [hazard ratio (HR), 1954.09], uterine cavity depth (HR, 16.63), MBLS (HR, 1.14), history of gonadotropin-releasing hormone agonist treatment in the previous 6 months (HR, 2.10), history of vaginal delivery (HR, 1.79) and history of cervical laceration (HR, 3.69). In conclusion, hysteroscopic LNG-IUD fixation reduces the rate of LNG-IUD expulsion, prolongs the time of LNG-IUD in the uterine cavity, reduces the time of postoperative vaginal bleeding, relieves the symptoms of dysmenorrhea and reduces the menstrual volume in the patients with adenomyosis. The present trial was retrospectively registered in the Chinese Clinical Trial Registry on 28th December 2023 (registration no. ChiCTR2300079233).
本研究旨在通过队列研究探讨宫腔镜下左炔诺孕酮宫内节育器（LNG-IUD）固定术治疗子宫腺肌病的疗效。该队列研究在温州医科大学附属金华医院（中国金华）进行。2020年6月至2022年6月期间，共招募了31例子宫腺肌病患者，并将其分为实验组和对照组。实验组接受宫腔镜下LNG-IUD固定术，对照组接受左炔诺孕酮宫内缓释系统常规植入术。评估的疗效指标包括LNG-IUD排出时间、术后阴道出血时间、痛经及月经失血评分（MBLS）。共有31名参与者完成了研究。实验组和对照组的LNG-IUD排出率分别为6.25%和60%（P<0.05）。实验组的LNG-IUD在位时间为20.50个月（Q1，15.75；Q3，24.00），对照组为10.00个月（Q1，6.50；Q3，15.00）（P<0.05）；实验组和对照组术后阴道出血时间分别为12.50天（9.25，16.25）和120.00天（75.00，120.00）（P<0.05）。多因素Cox回归分析显示，子宫腺肌病患者的LNG-IUD排出与宫腔镜下LNG-IUD固定术[风险比（HR），1954.09]、宫腔深度（HR，16.63）、MBLS（HR，1.14）、前6个月促性腺激素释放激素激动剂治疗史（HR，2.10）、阴道分娩史（HR，1.79）及宫颈裂伤史（HR，3.69）有关。总之，宫腔镜下LNG-IUD固定术可降低子宫腺肌病患者的LNG-IUD排出率，延长LNG-IUD在宫腔内的时间，减少术后阴道出血时间，缓解痛经症状并减少月经量。本试验于2023年12月28日在中国临床试验注册中心进行回顾性注册（注册号：ChiCTR23OO079233）。
