Clinical Observation And Meta-analysis On Therapeutic Regimen Of Lesion Excision Combined With The Insertion Of Levonorgestrel Releasing Intrauterine System For Uterine Adenomyosis

ObjectiveTo discuss clinical observation and meta-analysis on therapeutic regimen of lesion excision combined with the insertion of levonorgestrel releasing intrauterine system (Levonorgestrel-releasing Intrauterine System, LNG-IUS) for uterine adenomyosis.Methods(A) From December 2008 to December 2013,133 cases of patients were diagnosed as adenomyosis in Zhongda hospital. Relevant information has been collected, including the treatment program, the situation before and after the treatment of dysmenorrhea, menstrual flow adverse reactions, recurrence, and the quality of life. They are divided into three groups according to its treatment program: Group 1:lumpectomy treatment of adenomyosis group (48 cases); Group2:lumpectomy combined with postoperative GnRH-α and therapy uterus adenomyosis group (43 cases); Group3:lumpectomy combined with intrauterine placement LNG-IUS treatment of adenomyosis group (42 cases). The effect of curing method such as dysmenorrhea, the menstrual flow, adverse reaction, relapse, and quality of life of the patients from three groups has been analyzed.(B) Searched PubMed, Web of Science, EMbase, CNKI, WanFang Data, and VIP on the computer using search terms such as "adenomyosis, lesion resection, surgery,operation、Mirena、LNG-IUS、Levonorgestrel-Releasing Intrauterine System、 gonadotropin releasing hormone agonist, GnRH-agonist, GnRHa、Medicine treatment", and collected relevant randomized control and case control study that published abroad or domestic before April 2015 about the uterine lesion resection, excision combined with postoperative drug and LNG-IUS inserted treatment of adenomyosis. After the two researchers have included and excluded the criteria independently and screened the literature, extracted data and evaluated the quality, then carry on the Meta-analysis with the adoption of RevMan 5.3 software.Results(A) General information on the comparison results of the three groups shows that three groups are comparable in age, gravidity, parity, body mass index (BMI), dysmenorrhea (VAS score), blood loss (PBAC score), preoperative quality of life evaluation (WHOQOL-BREF scores), the comparison results showed no significant difference (P> 0.05). After treatment, comparing the Group3 with Groupl, the conclusion is gotten that there is a decrease of the amount of pre-menstrual, and the decrease of menstrual flow of Group3 (147.79±65.83)score is significantly more than Groupl (64.37±75.16)score, there is a statistically significance between the two groups(P<0.05); The score of the improvement of life quality:Group3 (4.42+ 2.91)score; Groupl (1.85±2.43)score, there is a statistically significance between two groups(P<0.05); Compared Group3 with Group2, the index shows no significant difference (P> 0.05).(B) Totally seven studies were brought into, and five were put into controlled trials randomly, the rest two are controlled trials for cases. Randomized controlled trials using the Jadad criteria for quality analysis, all five are high-quality articles., We use Newcastle-Ottawa scale (NO S) standard to evaluate the methodological quality of Case-control study, and these two studies are both high quality articles. Meta-analysis showed:compared with surgery alone group, the progestin intrauterine delivery system assisted excision group VAS score significantly reduced [P<0.00001, SMD=1.63,95% CI (1.33,1.93)]. Relapse rate is significantly less than surgery alone group [P=0.0001, OR=0.08,95%CI (0.02,0.29)]. However, compared with surgical adjuvant drug therapy group, the difference was not statistically significant [P=0.29, SMD=-0.19,95% CI (-0.55,0.16)].ConclusionsLevonorgestrel releasing intrauterine system assisted lumpectomy can significantly reduce the menstrual flow of patients with adenomyosis, and improve the dysmenorrhea symptoms, and there are fewer adverse reactions and complications with low recurrence rate, which can greatly improve the quality of patients’ life with significant clinical effect. The term efficacy was obviously better than the uterine lesion resection. Moreover, it was similar to the treatment with lumpectomy combined with postoperative GnRH-α.