Clinical research of uterine arterial embolization combined with levonorgestrel releasing intrauterine system in the treatment of adenomyosis
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摘要: 目的 探讨子宫动脉栓塞术联合左炔诺孕酮宫内缓释系统治疗子宫腺肌症的临床疗效,寻找子宫腺肌症有效的保守治疗方法。 方法 选择2013年1月—2015年12月在武汉科技大学附属孝感医院住院明确诊断为子宫腺肌症的患者78例,在月经干净后3~7 d,取4F cobra导管,经皮股动脉穿刺上行至子宫动脉,行子宫动脉栓塞术,术后2个月放置左炔诺孕酮宫内缓释系统。定期随访评估患者术后痛经的程度、月经量、盆腔B超监测子宫的大小及子宫内膜厚度、血清CA125的水平和卵巢功能的变化。 结果 子宫动脉栓塞术联合左炔诺孕酮宫内缓释系统治疗后第3、9、12个月痛经评分、PBAC评分、子宫内膜厚度、CA125和子宫的大小与子宫动脉栓塞术前比较,差异有统计学意义(P<0.05);放置曼月乐环后子宫体积大小与放置前比较,差异无统计学意义(P>0.05)。左炔诺孕酮宫内缓释系统治疗后有少部分患者出现少量阴道出血,但无一例出现环下移或脱落。在子宫动脉栓塞术前及术后2个月和放置左炔诺孕酮宫内缓释系统后第3、12个月监测血清性激素水平,各阶段血清FSH、LH、E2水平比较,差异均无统计学意义(均P>0.05),未提示有卵巢储备功能减退。 结论 子宫动脉栓塞术联合左炔诺孕酮宫内缓释系统治疗子宫腺肌症具有创伤小、安全性高、不影响卵巢功能的优势。
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关键词:
- 子宫动脉栓塞术 /
- 左炔诺孕酮宫内缓释系统 /
- 子宫腺肌症
Abstract: Objective To investigate the clinical effect of uterine artery embolization combined with Levonorgestrel(LNG)-releasing intrauterine system in the treatment of adenomyosis,and explore a conservative effective therapy of uterine adenomyosis. Methods Total 78 inpatients with histologically confirmed adenomyosis in hospital undergoing percutaneous common femoral artery(CFA) puncture for uterine artery embolization with the 4F Cobra catheter 3-7 days after their menstruation cycle.And the LNG-releasing intrauterine system was placed in two months after operation.The degree of dysmenorrhea,volume of menstrual flow,the size of the uterus and changes of the endometrial thickness by pelvic ultrasound,the level of serum CA125,and the function of ovary were evaluated on the regular follow-up evaluation. Results In 3,9 and 12 months after uterine artery embolization combined with LNG-releasing intrauterine system therapy,the dysmenorrhea score,PBAC score,endometrial thickness,CA125 level and the size of the uterus were improved as compared with those before the treatment,the difference was statistically significant(P<0.05).The volume of uterine after the placement of Mirena was not changed obviously,the difference was no significant(P>0.05).After the treatment,a small amount of vaginal bleeding occurred in a few patients,but the ring did not move down or fall off in any cases.The serum sex hormone levels(LH,E2 and FSH) before the uterine artery embolization,2 months after the surgery,and 3 and 12 months after LNG-releasing intrauterine system placement did not changed obviously,there were no significant differences(P>0.05),which did not show the reduced ovarian reserve function. Conclusion Uterine artery embolization combined with LNG-releasing intrauterine system for adenomyosis has the advantages of small trauma,high safety,not affecting ovarian function.
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