The Clinical Efficacy Of Mirena Treatment Of Adenomyosis

Objective: To evaluate the clinical efficacy of Mirena treatment of adenomyosis.Methods:1.88 patients with adenomyosis were surveyed from January 2012 to January 2014,in First People’s Hospital of Lianyungang City,Maternal and child health care hospital of LianyungangCity and Maternal and child health care of Lianyun District.According to the treatment can be divided into Mirena group and Gestrinone group.To observe two groups before treatment, treatment for six months,treatment for the last follow-up of patients with uterine volume,uterine endometrialthickness,dysmenorrhea,dysmenorrhea obviously alleviate rate, menstrual improvement rate and adverse reactions related indicators, using Excel and SPSS17.0 statistical software for statistical analysis, were compared between group differences and differences to explore the clinical effect of levonorgestrel releasing intrauterine system in treating adenomyosis.2.Through systematic review of the literature on Mirena treatment of adenomyosis related research evaluation system with meta analysis method, to provide a reference for adenomyosis treatment.Result:1.Trough the survey of 88 patients with adenomyosis,we can found:(1)Compared with before treatment, the uterine volume of Mirena group with treatment for six months and the last follow-up shrank from 152.87±61.56cm3 to134.41±54.57cm3 and 128.62±52.25cm3,respectively; the uterine volume of Gestrinone group shrank from 173.31±60.77cm3 to 153.75±52.90cm3 and 149.27±46.73cm3. Two groups of patients before treatment(P=0.12), treatment for six months(P=0.10), and the last follow-up(P=0.06) were not statistically significant.(2)Compared with before treatment, the endometrial thickness of Mirena group withtreatment for six months and the last follow-up reduced from 10.65±3.47 mm to7.04±1.73 mm and 5.31±1.46 mm,respectively;the endometrial thickness of Gestrinone group reduced from 10.40±3.40 mm to 7.95±2.31 mm and 6.33±1.93 mm,respectively.Two groups of patients before treatment(P=0.74),treatment for six months(P=0.04) and the last follow-up(P=0.01) were statistically significant.(3)Compared with before treatment,the dysmenorrhea VAS score of Mirena group therapy for six months and the last follow-up decreased from 7.38±1.27 to 3.27±0.71 and1.40±0.84; in Gestrinone group decreased from 7.08±1.33 to 3.68±1.05 and2.25±0.87.Two groups of patients before treatment(P=0.28),treatment for six months(P=0.04) and the last follow-up(P=0.00) were significantly different;two groups of patients for six months(P=0.80) and the last follow-up(P=0.20) significantly relieve dysmenorrhea rate differences were not statistically significant.(4) Two groups of patients treatment for six months(P=0.58), the last follow-up(P=0.83) no statistically significant difference were observed in the rate of menstruation obviously.(5)Two groups of patients last follow-up rate of adverse events(P=0.49) difference was not statistically significant.2.This meta-analysis included seven systematic reviews of clinical trials of case-controlled trials with 566 patients.None of grouping method was described in detail,nor does it mention whether blinded.Each study follow-up period was ranging from 6 months to 42 months.All studies were for Chinese literature.Meta-analysis showed that:(1)The uterine volume of two patients treatment for six months(P=0.46), treatment for 12 months(P=0.09) were not significantly different.(2)The endometrial thickness of two patients treatment for six months(P=0.00) was statistically significant different.While the difference of treatment for 12 months(P=0.09)was not statistically significant.(3)The dysmenorrhea response rate of treatment for six month(P=0.04) both were statistically significant different.(4)The 6 month period improved rate of two groups(P=0.31) were not statistically significant different.(5)The adverse reaction rate of two groups(P=0.05) were not statistically significant different.Conclusion:1.We find Mirena and Gestrinone treatment of adenomyosis can obtain good effect by survey.Mirena compared Gestrinone can more effectively treat the symptoms of adenomyosis,endometrial significantly thinner,and with time,the more obvious this change.There was no significant difference between Mirena and gestrinone in uterine volume shrink, menstrual obvious improvement rate, dysmenorrhea relief rate, adverse reaction rate and other aspects.2.Through Meta-analysis,Gestrinone treatment of adenomyosis compared Mirena can more effectively control symptoms of dysmenorrhea adenomyosis,treatment six months significantly reduced endometrial thickness,12 months of treatment to reduce endometrial no significant differences compared to the thickness;reduction in uterine volume,rate of improvement menstruation,irregular vaginal bleeding rate,with considerable effect gestrinone.So,for dysmenorrhea symptoms of adenomyosis patients may prefer Mirena treatment,worthy of promotion.3.Due to the limited quantity and quality of the research, the long-term effect of Mirena still need to more high quality, large sample RCT and CCT to verify it. To comply with the recommendations of evidence-based medicine, the development of standardized guideline for clinical research work will guide the clinical research.