The Clinic Treatment Observation Of GnRH-a Combining With LNG-IUS Treating The Mild,moderate Degree Uterine Adenomyosis

Objective: To explore that the therapeutic effects of the Gonadotropin releasing hormone agonist(Gn RH-a) combined with levonorgestrel-releasing intrauterine system LNG-IUS) on the treatment of mild and moderate degree uterine adenomyosis(AMS) and for the further purpose of providing evidence for the AMS indexing treatment system.Methods: Distinguishing patients of adenomyosis into mild, moderate and severe levels according to single-side uterine muscle thickness(front, back and bottom of uterine) or diameter of adenomyoma by B-ultrasound. 43 cases patients of mild and moderate degree adenomyosis were divided into two groups as A and B according to the different thickness of uterine wall(about 10mm). The thickness of uterine wall or diameter of adenomyoma in two groups are: A group(22 cases)MD: 30mm<L≤39mm;B group(21 cases)MD:40mm<L≤50mm。Gn RH-a(3.75mg) were injected within menstrual period in patients in two groups every four weeks,and LNG-IUS was placed in the uterine when the first injection.And stopped injecting Gn RH-a afer MD was adjusted to 30 mm. The scales of menstrual quantity and dysmenorrhea, as well as the uterine volumes and CA125 were respectively counted before Gn RH-a injected in different observation time.Result: 1、Significant changes of the scales of menstrual quantity and dysmenorrhea, the uterine volumes and CA125 were observed both in group A and B 3months,6 months and 12 months before and after treatment in different observation time(P<0.05).2、After 3months,6 months and 12 months treatment, significant different values of the scales of menstrual quantity and dysmenorrhea, the uterine volumes and CA125 were obviously lower in group A than before the treatment(P<0.05), while in group B, the changes were only showed in scales of menstrual quantity and dysmenorrheal before and after treatment in different observing time(P<0.05), but no significant were observed in the uterine volumes and CA125 in 12 months after treatment(P>0.05).3、In 12 months after the treatment, there was a patient having a recurrence in group A,and five in group B. The age, MD, uterus volume, CA125 level, dysmenorrhea score, menstrual quantity score in those patiens were(32.5±1.89) and(43.17±2.12)mm;Conclusion: 1、Gn RH-a combining with IUS has a kind of reliability for lesion degree when treating the adenomyosis.There is a good clinic effect on treating the adenomysis when the uterine muscle thickness or diameter of adenomyoma(L) between the 30 mm to 39 mm,and there is also a less recurrence rate. While MD is more than 40 mm, there is a more recurrence rate, which means the more Gn RH-a, the more side-effect.2、The age and MD are important factors in recurrence after stopping injecting Gn RH-a, the critical value is(32.5±1.89); MD is 43.17±2.12 mm.3、This research is an exploration about the thought and scheme of adenomyosis by graduation treatment. Meanwhile, to fix the thought of uterine adenomyosis by MD degree including standard provides an evidence-based basis.