Qiuju Li1, Ming Yuan1, Ni Li1, Qianwei Zhen1, Chang Chen1, Guoyun Wang1
1Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
Tóm tắt
AbstractAimsTo compare the efficacy of gonadotropin‐releasing hormone agonist (GnRH‐a) and GnRH‐a + levonorgestrel‐releasing intrauterine system (LNG‐IUS) after adenomyomectomy for improved adenomyosis‐associated symptoms.MethodsOverall, 193 patients with adenomyosis included in this study were categorized into three groups: adenomyomectomy (n = 57, group 1), adenomyomectomy + GnRH‐a (n = 83, group 2) and adenomyomectomy + GnRH‐a + LNG‐IUS (n = 53, group 3). Visual Analog Scale (VAS) scores and uterine volumes were determined to evaluate the severity of adenomyosis. Dysmenorrhea improvement and uterine volume were the main outcomes.ResultsThe VAS scores of all patients reduced from 7.3 (6.0, 8.5) to 0 (0, 0.6) at the 6 months after surgery, which were significantly higher in group 1 compared to other groups (P < 0.05). In groups 1, 2 and 3, there were 14, 7 and 4 patients, respectively, who suffered dysmenorrhea recurrence. The mean recurrent‐free‐survival (RFS) was 51.6 ± 2.4, 58.0 ± 1.2 and 58.3 ± 1.0 months, respectively, which was significantly shorter in group 1 (P < 0.05). The dysmenorrhea recurrences were 26.3%, 6.1%, 5.9% in groups 1, 2 and 3, respectively, at the 36 months, which was significantly higher in group 1 (P < 0.01). Significantly decreased uterine volumes were observed in all patients from 222.2 (147.6, 350.4) to 77.0 (65.9, 94.1) mL (P < 0.05) at the 6 month after surgery.ConclusionTreatment GnRH‐a and LNG‐IUS after surgery could significantly reduce the recurrence and prolong the RFS. It seemed that the use of LNG‐IUS was beneficial for a lower recurrence in long‐term follow‐up.
