| Objective:To explore the clinical application and adverse reactions of Levonorgestrel-releasing intrauterine system in the treatment of adenomyosis,to further evaluate its application value and prospect.Methods:The 110 AM patients who were treated in the gynecological clinic of our hospital from June 2017 to June 2019 for conservative treatment and no fertility requirement for the time being were randomly divided into Mirena group(40 cases),gonadotropin-releasing hormone analogue(Gonadotropin-releasing hormone analogue,GnRH-a)group(37 cases)and gestrinone group(33 cases)according to different treatment plans.Uterine volume,endometrial thickness,menstrual volume score,dysmenorrhea score,carbohydrate antigen 125(CAl25),FSH,LH and other indicators and adverse reactions were compared in and between groups before treatment,3 months and with 6 months after treatment.The collected data were statistically analyzed by one-way anova,nonparametric tests and t test using SPSS 22.0 statistical software.Results:1、VAS score and CA125 level: In each group,dysmenorrhea and CA125 level were significantly alleviated at 3 and 6 months after treatment(P < 0.01);The effects of Mirena group and GnRH-a group were similar,and the difference was not statistically significant(P > 0.05),The VAS score and CA125 level of the two groups were lower than that of the gestrinone group,and the difference between the two groups was statistically significant(P < 0.01).2、Uterine volume: the uterine volume of GnRH-a group at 3 and 6 months after treatment was significantly smaller than that before treatment(P < 0.01),and the uterine volume of Mirena group and gestrinone group at 3 months after treatment showed no significant change compared with that before treatment(P > 0.05),uterine volume at 6 months after treatment was significantly reduced compared with that before treatment,and the difference was statistically significant?(P < 0.05);The uterine volume of GnRH-a group at 3 and 6 months after treatment was significantly smaller than that of Mirena group and the gestrinone group at the same period(P < 0.01),there was no significant? difference in the uterine volume of Mirena group and the gestrinone group at 3 and 6 months after treatment(P > 0.05).3、Endometrium thickness: endometrium in each group shrank and became thinner at 3 and 6 months after treatment compared with before treatment,and the effect was more significant at 6 months after treatment(P < 0.01);There was no significant difference in the effect of Mirena group and GnRH-a group on endometrium 3 months after treatment(P > 0.05),and 6 months after treatment GnRH-a group?had a more significant effect on endometrial inhibition than Mirena group(P < 0.05),the effect of 3 and 6 months after treatment?on endometrial inhibition in both groups was greater than that in the gestrinone group(P < 0.01).4、PBAC score of menstrual volume: amenorrhea occurred in all patients in the GnRH-a group 3 months after treatment,and menstrual volume in the Mirena group and the gestrinone group significantly decreased 3 and 6 months after treatment compared with that before treatment(P < 0.01);The PBAC score of menstrual volume in the Mirena group at 3 and 6 months after treatment was lower than that in the gestrinone group,with significant statistical difference(P < 0.01).5、FSH and LH levels: no significant changes were observed in the levels of FSH and LH in the Mirena group at 3 and 6 months after treatment compared with before treatment(P > 0.05),and the levels of FSH and LH in the GnRH-a group and the gestrinone group significantly decreased at 3 and 6 months after treatment compared with before treatment(P < 0.01);The levels of FSH and LH in GnRH-a group at 3 and 6 months after treatment were lower than those in the gestrinone group(P < 0.01),and the levels of FSH and LH in both groups were lower than those in the Mirena group,with significant statistical difference(P < 0.01).6、Adverse reactions: in the Mirena group,irregular vaginal bleeding(32.5%),ovarian cyst(10%)and contraceptive device moves down(7.5%)were the main symptoms;in the GnRH-a group,amenorrhea(100%)and perimenopausal symptoms(29.7%)were the main symptoms;in the gestrinone group,acne(21.2%)and liver function abnormalities(15.1%)were the main symptoms.Conclusion:1、In the treatment of adenomyosis,Mirena,GnRH-a and gestrinone all obtained good therapeutic effects,and Mirena and GnRH-a had better curative effects.2、While Mirena has no obvious effect on ovarian function in the treatment of adenomyosis,GnRH-a has the most obvious inhibitory effect on ovarian function.However,GnRH-a is superior to Mirena and gestrinone in reducing uterine volume in the short term.3、The short-term efficacy of Mirena and GnRH-a in the treatment of adenomyosis is similar,but Mirena has higher economic benefit than GnRH-a,with less systemic adverse reactions and a long duration of efficacy,which is worthy of clinical promotion. |
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