[1]张纯溪,岳慧敏,张萍*,等.促性腺激素释放激素激动剂与左炔诺孕酮宫内节育器联合治疗子宫内膜不典型增生的临床疗效研究[J].中国计划生育和妇产科,2016,(6):56-58.
　ZHANG Chun-xi,YUE Hui-min,ZHANG Ping*,et al.The clinical efficacy observation of GnRH-agonist and levonorgestrel-releasing intrauterine device for the treatment of endometrial hyperplasia[J].Chinese Journal of Family Planning & Gynecotokology,2016,(6):56-58.
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促性腺激素释放激素激动剂与左炔诺孕酮宫内节育器联合治疗子宫内膜不典型增生的临床疗效研究
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2016年6期
页码:
56-58
栏目:
论著与临床
出版日期:
2016-06-25

文章信息/Info

Title:
The clinical efficacy observation of GnRH-agonist and levonorgestrel-releasing intrauterine device for the treatment of endometrial hyperplasia
作者:
张纯溪; 岳慧敏; 张萍*; 刘红
青岛市市立医院妇科
Author(s):
ZHANG Chun-xi;  YUE Hui-min;  ZHANG Ping*;  LIU Hong
Department of Gynecology, Qingdao Municipal Hospital, Qingdao Shandong 266011, P.R.China
关键词:
促性腺激素释放激素激动剂; 左炔诺孕酮宫内节育器; 子宫内膜不典型增生
Keywords:
GnRH-agonist; levonorgestrel-releasing intrauterine system; endometrial hyperplasia
分类号:
R 711.74
摘要:
目的探讨促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist，GnRHa)与左炔诺孕酮宫内节育器（曼月乐)联合治疗子宫内膜不典型增生（atypical hyperplasia of endometrium，AEH）的临床疗效。方法对2010年1月至2013年1月在青岛市市立医院妇科就诊的32例AEH患者给予GnRHa与曼月乐联合治疗。每隔4周皮下注射一次GnRHa，共用药3个周期。于第1次注射后月经第3～5 d 放置曼月乐。比较治疗前、治疗第4、7、13个月内膜厚度及月经量变化。13个月后取出曼月乐行诊断性刮宫，观察子宫内膜病理学形态，然后有生育要求者行助孕，无生育要求者宫腔内曼月乐继续放置。结果所有患者治疗前月经PBAC评分平均为（1378±449）分，治疗第4、7、13个月月经PBAC 评分分别为（357±128）分、（226±79）分及（122±27）分，与治疗前比较差异均有统计学意义(P<005)。治疗前内膜厚度为（148±43） mm，治疗第4、7、13个月子宫内膜厚度分别为（86±21） mm、（62±25）mm及（53±14） mm，与治疗前比较差异均有统计学意义 (P<005)。子宫内膜病理结果：18例轻度AEH均逆转为子宫内膜间质蜕膜样变；10例中度AEH中8例逆转为子宫内膜间质蜕膜样变，2例逆转为乳头状增生，伴间质水肿；4例重度AEH中1例逆转为子宫内膜间质蜕膜样变，3例逆转为乳头状增生，伴间质水肿。结论GnRHa与曼月乐联合应用能逆转AEH，有效减少子宫内膜增生患者的月经量，对有生育要求或者要求保留子宫的患者是一种较为有效的保守治疗方式。
Abstract:
ObjectiveTo investigate the effect of gonadotropin-releasing hormone agonist (GnRHa) and levonorgestrel-releasing intrauterine device (Mirena) in the treatment of endometrial hyperplasia. Methods32 patients who were diagnosed as atypical hyperplasia of endometrium (AEH) in Qingdao Municipal Hospital from January 2010 to Junuary 2013 were analyzed. All the patients were treated by GnRHa every 4 weeks and Mirena was inserted after the GnRHa was treated for the first time. After 3 pharmacy cycles, endometrial thickness and the PBAC score of menstrual flow were observed before GnRHa treated and four months，seven months and thirteen months after Mirena inserted. Mirena taken out, and diagnostic curettage were performed after 13 months, observed pathological form of endometrium. Then helped those who had fertility requirements, and placed Mirena in those who had no fertility requirements. ResultsThe PBAC scores of menstrual flow were respectively1378±449，357±128，226±79 and 122±27 before treated and four months，seven months and thirteen months after treated，the difference was significant statistically (P<005). Endometrial thickness were respectively 148±43 mm，86±21 mm、62±25 mm and 53±14 mm before treated and four months，seven months and thirteen months after treated, the difference was significant statistically (P<005).The pathological diagnoses of endometrium: 18 cases with mild AEH were reversed to the endometrial stroma; in 10 cases with moderate AEH, 8 cases were reversed to endometrial stroma, and 2 cases of papillary hyperplasia, with interstitial edema; in 4 cases with severe AEH, 1 case of endometrial stroma, and 3 cases of papillary hyperplasia, with interstitial edema. ConclusionGnRHa and Mirena can reverse endometrial hyperplasia. And it is also effective in reducing menstrual flow. This is an effective conservative treatment for the patients who need to retain fertility.

参考文献/References:

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备注/Memo

备注/Memo:
公共领域科技支撑计划项目（项目编号：2014-14-033-YY）
更新日期/Last Update: 1900-01-01