Clinical Analystis Of Transcervical Resection Of Endometrium With LNG-IUS In Treatment Of Adenomysis

Objective:To compare the clinical value of levonorgestrel-releasing intrauterine system(LNG-IUS,trade name Mirena),hysteroscopic resection of endometrium(TCRE) and transcervical resection of endometrium with LIN-IUS in treatment of the patients with adenomysis(AM). All of these were in order to find an effective,reliable and ideal treatment.Methods:A study of 75 patients who were diagnosed adenomyosis and wanted to keep the uterus but had no fertility requirements or had no fertility requirements at that moment in the 1st hospital of Jilin University(2013 May-2015 Mar.) were divided into three different treating methods according to the conditions and requirements of patients,including TCRE group(n=23), Mirena group(n=25) and combined group(n=27).Visual Analogue Score(VAS) 、 Sensation Quantity Scale(SQS)、uterus volume、endometrial thickness、anemia and postoperative complications were observed after 1month, 3months, 6months, 12 months.Results:1. General information: there were no statistical difference in patients, age, numbers of pregnancy,times of production, VAS, SQS, size of uterus volume, thickness of uterus endomembrane and other aspects of the three groups(P>0.05).2. VAS:VAS of the combined group had no statistical difference with TCRE group and Mirena group after 1 month,3 months,6nomths(P>0.05);12 months after treatment,the VAS was obviously increased in the TCRE group, compared with the other two groups the results had statistical difference(P<0.05), but there was no statistical difference between Mirena group and combined group after 12 months treatment(P>0.05).3. SQS: SQS of the combined group and TCRE group were significantly lower than Mirena group after 1 month,3 months,6 months,12 months,there had statistical difference(P < 0.05); SQS of combined group had no significant difference with TCRE group after 1 month, 3 months, 6 months(P>0.05); 12 months after treatment, the SQS was increased in the TCRE Group, then SQS of the combined group had statistical difference with TCRE group after 12 months(P<0.05).4. Variation of uterus volume: size of uterus volume of the combined group had no significant difference with TCRE group and Mirena group(P>0.05); Although the size of uterus volume in TCRE group was increased and bigger than the other two grouphs after 12 months, there had no statistical difference(P>0.05).5.Variation of uterus endomembrane: endometrial thickness of combined group and TCRE group were thinner than Mirena group after 1 month,3 months,6 months,12 months, there had statistical significances(P<0.05); uterus endomembrane thickness of combined group has no significant difference between TCRE group after 1 month,3 months,6 months(P>0.05), but uterus endomembrane thickness of TCRE group was increased after 12 months, there had statistical difference with combined group(P<0.05).6.Variaion of anemia: although combined group improved anemia was better than the other two grouphs, there had no statistical difference(P>0.05).The three groups were all without anemia after 6 months.7. Postoperative complications: one case underwent totalhy sterectomy and the other case underwent subtotal hysterectomy in the combined group; one case had cervical adhesion and other 5 cases were considered as postoperative recurrence in the TCRE group; 5 cases had a ring down and 3 cases were taked out the ring in the Mirena group.Conclusion:1、TCRE combined Mirena can control the recurrence of vaginal bleeding, dysmenorrhea and other negative phenomenons effectively after TCRE.2、TCRE combined Mirena can resolve the problems of irregular bleeding caused by application of Mirena.3、TCRE combined Mirena is an effective, reliable and ideal treatment method to the patients who had no fertility requirements and want to keep the uterus worth to spread in clinic.