Clinical Analysis Of 185 Cases Of Abnormal Uterine Bleeding Treated By Combining With Levonorgestrel Releasing Intrauterine System During Hysteroscopy

Objective:To explore the efficacy,adverse reactions and the shedding rate of LNG-IUS in abnormal uterine bleeding(AUB)patients treated by combining with levonorgestrel releasing intrauterine system(LNG-IUS)during hysteroscopy,to provide guidance for clinical treatment.Methods:A total of 2,194 AUB patients who treated by hysteroscopy from the department of general gynecology of the First Hospital of Jilin University between January 2014 and December 2018 were collected;among them,185 patients were treated combined with LNG-IUS,and 138 patients were followed up by telephone until June 2019,47 patients lost to follow-up.The clinical data of all patients were collected and analyzed.The database was established by using Excel software,SPSS 22.0 software was used for statistical analysis,the data were analyzed by chi-square test,p < 0.05 was statistically significant.Results:1.AUB patients treated by combining with LNG-IUS during hysteroscopy were more common in women aged 40-49 years(60.0%),the clinical manifestations were mostly irregular uterine bleeding(70.8%),menorrhagia(51.4%),and mild to moderate anemia(89.7%),about half(51.3%)of the women had endometrium thickening of varying degrees showed by ultrasonography,with the preposition of the uterus(63.8%)mostly,the length of the uterine cavity is mostly 7-9cm(77.6%).The single etiology was mostly endometrial polyps(51.0%)and ovulatory dysfunction uterine bleeding(30.1%).2.Postoperative adverse reactions of AUB patients treated by combining withLNG-IUS during hysteroscopy were mostly breast tenderness(26.8%)and abdominal and/or pelvic distention discomfort(29.7%).(Considered to be related to ovarian hormone imbalance in perimenopausal patients,etc).3.The incidence of postoperative adverse reactions of AUB patients treated by combining with LNG-IUS during hysteroscopy was different in the distribution of different duration of LNG-IUS and different causes,and the difference was not statistically significant(P >0.05).Patients aged ≥50 years old were more likely to have abdominal and/or pelvic distention discomfort than patients of other ages,with statistically significant differences(P<0.05).4.In AUB patients treated by combining with LNG-IUS during hysteroscopy,there was no significant difference in the shedding rate of LNG-IUS in different duration of LNG-IUS,different ages,different pregnancies,different etiology,dysmenorrhea,different uterine position and different uterine cavity length(P>0.05).The shedding rate of LNG-IUS was higher in patients with preoperative menorrhagia than in patients with non-preoperative menorrhagia,and the difference was statistically significant(P<0.05).5.In AUB patients treated by combining with LNG-IUS during hysteroscopy,postoperative amenorrhea,decreased menstrual blood and infrequent menstruation were effective for the treatment,and the effective rate was 89.9%.There were 58 cases of dysmenorrhea and 48 cases of dysmenorrhea remission after operation,with a dysmenorrhea remission rate of 82.8%.6.In AUB patients treated by combining with LNG-IUS during hysteroscopy,the amenorrhea rate of patients with LNG-IUS 4-5 years reached 75.0%,but the difference was not statistically significant compared with patients with LNG-IUS less than 4 years(P > 0.05).The treatment effect of hysteroscopy combined with LNG-IUS for AUB of different etiology was different,and the difference was not statistically significant(P>0.05).7.In AUB patients treated by combining with LNG-IUS during hysteroscopy,there was no significant difference in the distribution of dysmenorrhea remission ratein different duration of LNG-IUS and different causes(P>0.05).8.In AUB patients treated by combining with LNG-IUS during hysteroscopy,only one patient with endometrial polypoid hyperplasia had disease recurrence,and the recurrence rate of AUB treated by combining with LNG-IUS during hysteroscopy was 0.72%.Conclusion:1.The effective rate was high,the remission rate of dysmenorrhea was high,the shedding rate of LNG-IUS and the disease recurrence rate were low in AUB patients treated by combining with LNG-IUS during hysteroscopy.2.Combining with LNG-IUS during hysteroscopy has a significant effect for the treatment of AUB caused by different etiologies,especially for endometrial polyps and ovulatory dysfunction uterine bleeding.3.LNG-IUS can be placed immediately during hysteroscopy,which can correct the position of LNG-IUS in the uterine cavity,avoid the intrauterine manipulation again,and reduce the pain and economic burden of patients.