| 摘要: |
| ［摘要］ 目的 探索宫腔镜下左炔诺孕酮宫内缓释系统（LNG-IUS）宫底非缝合固定术之盘扣悬挂法治疗子宫腺肌病的可行性及临床效果。方法 选取2024年1月至2025年3月首都医科大学附属北京天坛医院收治的采用宫腔镜盘扣悬挂法固定LNG-IUS治疗的44例子宫腺肌病患者，收集患者的一般信息、临床表现、手术时间、手术并发症、术后LNG-IUS脱落情况及其他随访资料，采用自身前后对照的方法对手术效果进行评估。结果 共纳入44例患者，年龄为（40.16±4.54）岁，孕次为（2.30±1.62）次，产次为（1.14±0.80）次，宫腔深度为（10.58±1.03）cm，子宫体积为130.31（90.60，174.04）mL，手术时间为（14.54±5.01）min，术中出血量为（4.59±3.34）mL。其中痛经36例（81.82%），月经过多44例（100.00%），贫血23例（52.27%），既往有LNG-IUS脱落史17例（38.64%），LNG-IUS下移史7例（15.91%）。44例患者中，13例同时行宫腔镜子宫内膜息肉电切术，3例同时行子宫黏膜下肌瘤电切术，24例同时行吸宫薄化内膜。所有患者均未出现子宫穿孔、大出血、液体超负荷和术后感染等并发症。术后平均随访时间为（7.01±1.20）个月，所有患者均未发生LNG-IUS脱落。术后6个月随访结果显示，痛经有效率为91.67%（33/36），月经过多有效率为95.45%（42/44）。患者术后1个月的血红蛋白为124.00（114.50，130.00）g/L，较术前［108.00（96.25，118.750）g/L］有明显提升（Z=5.661，P<0.001）。术后1个月及6个月月经失血图（PBLAC）评分、视觉模拟量表（VAS）评分及子宫体积较术前下降，差异有统计学意义（P<0.05）。结论 宫腔镜下LNG-IUS宫底非缝合固定术之盘扣悬挂法是一种安全有效的技术，尤其适用于既往有LNG-IUS脱落史或下移史的子宫腺肌病患者。该手术方法操作简单、微创、手术时间短、出血量少且术后恢复快，值得临床推广应用。 |
| 关键词: 左炔诺孕酮宫内缓释系统 盘扣悬挂法 宫腔镜 子宫腺肌病 |
| DOI：10.3969/j.issn.1674-3806.2025.11.05 |
| 分类号:R 711.74 |
| 基金项目: |
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| Analysis on the clinical efficacy of hysteroscopic LNG-IUS non-suture fixation in treatment of adenomyosis |
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ZHANG Luping, ZHANG Shengpeng, LI Jinghua, FENG Limin
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Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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| Abstract: |
| ［Abstract］ Objective To explore the feasibility and clinical efficacy of a novel hysteroscopic levonorgestrel-releasing intrauterine system(LNG-IUS) non-suture fixation in treatment of adenomyosis. Methods Forty-four patients with adenomyosis who were admitted to Beijing Tiantan Hospital, Capital Medical University from January 2024 to March 2025 and were treated with hysteroscopic LNG-IUS non-suture fixation for adenomyosis were selected. The patients′ general data, clinical manifestations, operative duration, operative complications, postoperative LNG-IUS expulsion and other follow-up data were collected. The operation effects were assessed by using a one way ANOVA paired T test. Results A total of 44 patients were included, with average age of (40.16±4.54)years, average number of pregnancy of (2.30±1.62), average number of delivery of (1.14±0.80), average uterine cavity depth of (10.58±1.03)cm, average uterine volume of 130.31(90.60, 174.04)mL, average operative duration of (14.54±5.01)min, and intraoperative blood loss of (4.59±3.34)mL. Among them, there were 36 cases(81.82%) of dysmenorrhea, 44 cases(100.00%) of menorrhagia, 23 cases(52.27%) of anemia, 17 cases(38.64%) with a history of LNG-IUS expulsion, and 7 cases(15.91%) with a history of LNG-IUS dislodgement. Among the 44 patients, 13 patients underwent hysteroscopic electroresection of endometrial polyps simultaneously, and 3 patients underwent electroresection of submucosal myoma of the uterus simultaneously, and 24 patients underwent aspiration of uterine lining to thin the endometrium at the same time. None of the patients presented with complications such as uterine perforation, massive hemorrhage, fluid overload and postoperative infection. The average postoperative follow-up time was (7.01±1.20)months, and no postoperative LNG-IUS expulsion occurred in all the patients. The follow-up results at 6 months after the operation showed that the effective rate of dysmenorrhea was 91.67%(33/36), and the effective rate of menorrhagia was 95.45%(42/44). At 1 month after the operation, the hemoglobin content of the patients was 124.00(114.50, 130.00)g/L, which was significantly increased compared with that before the operation［108.00(96.25, 118.75)g/L］(Z=5.661, P<0.001). At 1 month and 6 months after the operation, the patients′ menstrual Pictorial Blood Loss Assessment Chart(PBLAC) scores, Visual Analogue Scale(VAS) scores for dysmenorrhea, and uterine volume were decreased compared with those before the operation, and the differences were statistically significant(P<0.05). Conclusion The hysteroscopic LNG-IUS non-suture fixation is a safe and effective technique, especially suitable for adenomyosis patients with a history of LNG-IUS expulsion or a history of LNG-IUS dislodgement. This surgical method is simple to operate, minimally invasive, with a short operation time, less hemorrhage and a quick postoperative recovery in the patients, and thus is worthy of clinical application. |
| Key words: Levonorgestrel-releasing intrauterine system(LNG-IUS) Non-suture fixation Hysteroscope Adenomyosis |
