| Objective: To analyze the clinical effect of laparoscopic resection of adenomyosis combined with gonadotropin releasing hormone agonist(Gn RH-a)and levonorgestrel intrauterine sustained release system(LNG-IUS,Mirena)in the treatment of adenomyosis.Methods: From January 1,2010 to December 31,2016,92 patients with adenomyosis were treated by laparoscopic resection in Dalian Obstetrics and Gynecology Hospital.According to the different treatment methods,the patients were divided into laparoscopic resection group(28 cases)were divided into no treatment group.After laparoscopic adenomyosis resection combined with gonadotropin releasing hormone agonist group(30 cases)were divided into Gn RH-a group;Laparoscopic adenomyosis resection combined with levonorgestrel intrauterine sustained-release system group(14cases)was divided into Mirena group;Mirena combined with gonadotropin releasing hormone agonist(Gn RH-a)after laparoscopic resection of adenomyosis were divided into joint group.The menstrual volume,dysmenorrhea,adverse reactions and fertility of patients with fertility requirements were compared and analyzed at 6 months,12 months and 24 months after operation.Results: The amount of menstruation after operation in four groups: 6 months,12 months and 24 months after operation were significantly decreased compared with those before operation(P< 0.05),and there was a significant difference between the two groups(P< 0.05).The menstrual volume of Mirena group and combined group both decreased with time and tended to be stable,while the menstrual volume of no treatment group and Gn RH-a group both showed an increasing trend with time.Comparison between groups: there were significant differences in menstrual volume among 4 groups in 6 months,12 months and 24 months after operation(P<0.05).There were significant differences in menstrual volume between no treatment group and Gn RH-a group with joint group at 6 months,12 months and 24 months after operation(P<0.05),and there was a significant difference among these groups(P <0.05).The menstrual volume in the no treatment group and the Mirena group was 12 months after operation and 24 months after operation(P<0.05),while there was no significant difference in menstruation between the two groups 6 months after operation(P >0.05).There was significant difference between Gn RH-a group and Mirena group in 6 months,12 months and 24 months after operation(P<0.05).There was a significant difference between the two groups at 6 months after operation and 12 months after operation(P<0.05),but there was no significant difference between the two groups at 24 months after operation(P>0.05).Postoperative dysmenorrhea in four groups: intra-group comparison: patients 6 months,12 months,24 months after operation compared with preoperative dysmenorrhea score significantly decreased(P<0.05),the difference was statistically significant.Comparison between groups: there were significant differences in dysmenorrhea score between the four groups in 6 months,12 months and 24 months after operation(P<0.05).There was significant difference in dysmenorrhea score between no treatment group and the Gn RH-a group at 6 months,12 months and 24 months after operation(P<0.05).There was significant difference in dysmenorrhea score between no treatment group and the Mirena group at 12 months and 24 months after operation(P<0.05).There was significant difference in dysmenorrhea score between no treatment group and the combined group at 12 months and 24 months after operation(P<0.05).There was no significant difference in dysmenorrhea score between Gn RH-a group and Mirena group at 6 months,12 months and 24 months after operation(P>0.05).There was no significant difference in dysmenorrhea score between GnRH-a group and combined group at 6 months after operation,12 months after operation and 24 months after operation(P > 0.05).There was no significant difference in dysmenorrhea score between the Mirena group and the combined group at 6 months,12 months and 24 months after operation(P>0.05).There were 7 cases(7/28)recurred rate of 25% in the no treatment group,and 2 cases(2/30)in the Gn RH-a group,with a recurrence rate of 6.7%,and both dysmenorrhea symptoms were the first symptoms of recurrence.The recurrence rate of the group without treatment was significantly higher than that of the group of Gn RH-a.There were 7 cases(7/30)in Gn RH-a group with low estrogen symptoms,including irritability,decreased libido,hair loss,irregular vaginal bleeding,etc.The symptoms were alleviated by using Remifemin Tablets in reverse,and the symptoms disappeared 3-6 months after withdrawal.In the Mirena group,5patients(5/14)had varying degrees of vaginal drip bleeding,low back pain,breast distension and other adverse reactions,while in the combined group 2(2/14)patients had varying degrees of vaginal drip bleeding and low back pain breast pain and other adverse reactions,without special treatment,gradually disappeared within 6 months.There were 3 cases of successful pregnancy in the no treatment group and 1 case of natural pregnancy.In the Gn RH-a group,there were 5 cases of successful pregnancy,2cases of natural pregnancy,2 cases of sccessful pregnancy through assisted reproductive technology.All of the above 4 cases were terminated by full term cesarean section.One patient was in the second trimester of pregnancy.All patients in the Mirena group and the combined group had no fertility requirements.Conclusion: Laparoscopic resection of adenomyosis has a certain clinical effect in the treatment of adenomyosis,but the recurrence rate is high.After resection of the lesion combined with Gn RH-a,the short-term effect is obvious in the treatment of increased menstrual volume,and there is a certain recurrence rate in the long term.The long-term effect of lesion resection combined with Mirena in the treatment of increased menstrual volume is better than that of Gn RH-a;combined with Gn RH-a or Mirena Le in the treatment of dysmenorrhea.After lesion resection,combined with Gn RH-a or Mirena in the treatment of increased menstrual volume and dysmenorrhea,both short-term and long-term effects are better,and the recurrence rate and the incidence of adverse reactions are relatively low.Because Gn RH-a is expensive and needs regular injection,the appropriate follow-up treatment should be considered according to the wishes of the patients. |
PDF Full Text Request