Please wait a minute...
浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (2): 136-141    DOI: 10.3785/j.issn.1008-9292.2019.04.03
    
The second generation endometrial ablation (NovaSure) improves efficacy of levonorgestrel-releasing intrauterine system in management of adenomyosis
LOU Junyao(),HUANG Xiufeng,ZHANG Lifeng,XU Ping,ZHANG Xinmei,CHEN Zhengyun*()
Department of Gynecology, the Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
Download: HTML( 9 )   PDF(913KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To determine the efficacy of second generation endometrial ablation (NovaSure) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods: Clinical data of patients with adenomyosis admitted in Women's Hospital, Zhejiang University School of Medicine from January 2015 to December 2018 were retrospectively analyzed. Among 66 patients, 44 received Mirena placement only (control group) and 22 received Mirena placement and NovaSure treatment (study group). The menstruation blood loss, dysmenorrhea score, uterine size, expulsion rate of Mirena and the patients' satisfaction rate were assessed in two groups. Results: There was a significant reduction in menstruation blood loss (P < 0.05) and significant improvement in dysmenorrhea (P < 0.05) after the treatment in both groups. The patients in study group had more marked improvement in menstruation blood loss than those in control group (P < 0.05). The patients' satisfaction was higher and the expulsion rate of Mirena was lower in study group than that in control group (all P < 0.05). The score of dysmenorrhea and the size of uterine had no significant difference between two groups (all P>0.05). Conclusion: NovaSure can improve the efficacy of Mirena in treatment of adenomyosis.

Key words： Adenomyosis/drug therapy      Endometrium/surgery      Catheter ablation      Intrauterine devices, medicated      Levonorgestrel      Treatment outcome     
Received: 26 January 2019      Published: 24 July 2019
CLC:  R711.74  
Corresponding Authors: CHEN Zhengyun     E-mail: 5515022@zju.edu.cn;5504004@zju.edu.cn
Service
E-mail this article
Add to my bookshelf
Add to citation manager
E-mail Alert
RSS
Articles by authors
LOU Junyao
HUANG Xiufeng
ZHANG Lifeng
XU Ping
ZHANG Xinmei
CHEN Zhengyun
Cite this article:

LOU Junyao,HUANG Xiufeng,ZHANG Lifeng,XU Ping,ZHANG Xinmei,CHEN Zhengyun. The second generation endometrial ablation (NovaSure) improves efficacy of levonorgestrel-releasing intrauterine system in management of adenomyosis. J Zhejiang Univ (Med Sci), 2019, 48(2): 136-141.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.04.03     OR     http://www.zjujournals.com/med/Y2019/V48/I2/136


第二代子宫内膜消融术可提高左炔诺孕酮宫内节育系统对子宫腺肌病患者的疗效

目的: 探讨第二代子宫内膜消融术（诺舒）联合左炔诺孕酮宫内节育系统（曼月乐）治疗子宫腺肌病的疗效。方法: 回顾性分析2015年1月至2018年12月在浙江大学医学院附属妇产科医院接受单独曼月乐治疗（对照组，44例）和诺舒联合曼月乐治疗（观察组，22例）的子宫腺肌病患者的月经量、痛经改善情况、子宫大小、曼月乐脱落事件和患者满意度。结果: 与治疗前比较，两种治疗均可改善患者月经量和痛经（均P < 0.05）；与对照组比较，观察组患者月经量改善更明显，曼月乐脱落事件发生率更低、患者满意度更高（均P < 0.05）；两组间的痛经评分和子宫大小变化无差异（均P>0.05）。结论: 诺舒有助于提高曼月乐在子宫腺肌病患者中的疗效。


关键词： 子宫腺肌病/药物疗法,  子宫内膜/外科学,  导管消融术,  宫内避孕器, 含药,  左炔诺孕酮,  治疗结果 
[1]   中华医学会妇产科学分会子宫内膜异位症协作组 . 子宫内膜异位症的诊治指南[J]. 中华妇产科杂志, 2015, 50 (3): 162- 169
Cooperative Group of Endometirosis, Chinese Society of Obstetrics and Gynecology . Guideline for the diagnosis and treatment of endometriosis[J]. Chinese Journal of Obstetrics and Gynecology, 2015, 50 (3): 162- 169
[2]   谢幸 . 妇产科学[M]. 8版 北京: 人民卫生出版社, 2013: 274- 275
XIE Xing . Obstetrics and Gynecology[M]. 8th ed Beijing: People's Medical Publishing House, 2013: 274- 275
[3]   MCCAUSLAND V , MCCAUSLAND A . The response of adenomyosis to endometrial ablation/resection[J]. Hum Reprod Update, 1998, 4 (4): 350- 359
doi: 10.1093/humupd/4.4.350
[4]   STRUBLE J , REID S , BEDAIWY M A . Adenomyosis:a clinical review of a challenging gynecologic condition[J]. J Minim Invasive Gynecol, 2016, 23 (2): 164- 185
doi: 10.1016/j.jmig.2015.09.018
[5]   PROPST A M , QUADE B J , GARGIULO A R et al. Adenomyosis demonstrates increased expression of the basic fibroblast growth factor receptor/ligand system compared with autologous endometrium[J]. Menopause, 2001, 8 (5): 368- 371
doi: 10.1097/00042192-200109000-00012
[6]   DUEHOLM M . Minimally invasive treatment of adenomyosis[J]. Best Pract Res Clin Obstet Gynaecol, 2018, 51 119- 137
doi: 10.1016/j.bpobgyn.2018.01.016
[7]   KAUFFMAN R P . Review:levonorgestrel IU system, OCPs, and antifibrinolytics each reduce bleeding in endometrial dysfunction[J]. Ann Intern Med, 2013, 159 (6): JC10
doi: 10.7326/0003-4819-159-6-201309170-02010
[8]   李雷, 冷金花, 戴毅 et al. LNG-IUS治疗子宫腺肌病相关重度痛经的前瞻性研究[J]. 中华妇产科杂志, 2016, 51 (5): 424- 430
LI Lei , LENG Jinhua , DAI Yi et al. A prospective cohort study on effects of levonorgestrel-releasing intrauterine system for adenomyosis with severe dysmenorrhea[J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51 (5): 424- 430
[9]   PHILIP C A , LE M M , MAILLET L et al. Evaluation of NovaSure? global endometrial ablation in symptomatic adenomyosis:a longitudinal study with a 36 month follow-up[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 227 46- 51
doi: 10.1016/j.ejogrb.2018.04.001
[10]   冯缵冲, 邵敬於 . 实用宫腔镜学[M]. 上海: 上海医科大学出版社, 1999: 108- 109
FENG Zuanchong , SHAO Jingyu . Practice of hysteroscopy[M]. Shanghai: Shanghai Medical University Publishing House, 1999: 108- 109
[11]   KIM M K , CHON S J , LEE J H et al. Postoperative levonorgestrel-releasing intrauterine system insertion after gonadotropin-releasing hormone agonist treatment for preventing endometriotic cyst recurrence:a prospective observational study[J]. Reprod Sci, 2018, 25 (1): 39- 43
doi: 10.1177/1933719117718274
[12]   LIN C J , HSU T F , CHANG Y H et al. Postoperative maintenance levonorgestrel-releasing intrauterine system for symptomatic uterine adenomyoma[J]. Taiwan J Obstet Gynecol, 2018, 57 (1): 47- 51
[13]   张信美, 许泓, 黄秀峰 et al. 左炔诺孕酮宫内缓释系统治疗子宫腺肌病的长期疗效观察[J]. 中华妇产科杂志, 2009, 44 (9): 694- 696
ZHANG Xinmei , XU Hong , HUANG Xiufeng et al. Long-term outcomes of LNG-IUS for treatment of adenomyosis[J]. Chinese Journal of Obstetrics and Gynecology, 2009, 44 (9): 694- 696
doi: 10.3760/cma.j.issn.0529-567x.2009.09.016
[14]   CIM N , SOYSAL S , SAYAN S et al. Two years follow-up of patients with abnormal uterine bleeding after insertion of the levonorgestrel-releasing intrauterine system[J]. Gynecol Obstet Invest, 2018, 83 (6): 569- 575
doi: 10.1159/000480012
[15]   MUNRO M G . Endometrial ablation[J]. Best Pract Res Clin Obstet Gynaecol, 2018, 46 120- 139
doi: 10.1016/j.bpobgyn.2017.10.003
[16]   ZHANG P , SONG K , LI L et al. Efficacy of combined levonorgestrel-releasing intrauterine system with gonadotropin-releasing hormone analog for the treatment of adenomyosis[J]. Med Princ Pract, 2013, 22 (5): 480- 483
doi: 10.1159/000351431
[17]   李雷, 冷金花, 贾双征 et al. 左炔诺孕酮宫内缓释系统治疗子宫腺肌病计划外取出和脱落情况及其相关因素分析[J]. 中国实用妇科与产科杂志, 2016, 32 (11): 1088- 1092
LI Lei , LENG Jinhua , JIA Shuangzheng et al. Analysis of unplanned taking-out and expulsion of LNG-IUS and related factors during the treatment of symptomatic adenomyosis[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2016, 32 (11): 1088- 1092
[18]   SCORDALAKES C , DELROSARIO R , SHIMER A et al. Efficacy and patient satisfaction after NovaSure and Minerva endometrial ablation for treating abnormal uterine bleeding:a retrospective comparative study[J]. Int J Womens Health, 2018, 10 137- 145
doi: 10.2147/IJWH
[19]   COOPER J , GIMPELSON R , LABERGE P et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia[J]. J Am Assoc Gynecol Laparosc, 2002, 9 (4): 418- 428
doi: 10.1016/S1074-3804(05)60513-0
[20]   PENNINX J P , MOL B W , ENGELS R et al. Bipolar radiofrequency endometrial ablation compared with hydrothermablation for dysfunctional uterine bleeding:a randomized controlled trial[J]. Obstet Gynecol, 2010, 116 (4): 819- 826
doi: 10.1097/AOG.0b013e3181f2e3e3
[21]   ELMARDI A , FURARA S , KHAN F et al. NovaSure impedance controlled system for endometrial ablation:the experience of the first UK reference centre[J]. J Obstet Gynaecol, 2009, 29 (5): 419- 422
doi: 10.1080/01443610902932291
[22]   NAKAMURA K , NAKAYAMA K , SANUKI K et al. Long-term outcomes of microwave endometrial ablation for treatment of patients with menorrhagia:a retrospective cohort study[J]. Oncology Letters, 2017, 14 (6): 7783- 7790
[23]   MCCAUSLAND A M , MCCAUSLAND V M . Depth of endometrial penetration in adenomyosis helps determine outcome of rollerball ablation[J]. Am J Obstet Gynecol, 1996, 174 (6): 1786- 1794
doi: 10.1016/S0002-9378(96)70211-9
[24]   陈富强, 张爱凤, 王小波 . 子宫内膜电切术联合左炔诺孕酮宫内节育系统治疗子宫腺肌病的前瞻性研究[J]. 上海交通大学学报(医学版), 2017, 37 (5): 641- 645
CHEN Fuqiang , ZHANG Aifeng , WANG Xiaobo . Prospective study of the treatment of adenomyosis by combining hysteroscopic transcervical resection of endometrium with levonorgestrel-releasing intrauterine system[J]. Journal of Shanghai Jiaotong University(Medical Sciences), 2017, 37 (5): 641- 645
doi: 10.3969/j.issn.1674-8115.2017.05.014
[1] ZHANG Lifeng,YANG Hui,ZHANG Xinmei,CHEN Zhengyun. Efficacy and adverse effects of levonorgestrel-releasing intrauterine system in treatment of adenomyosis[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 130-135.
[2] ZHANG Xinmei,XU Ping. Stratified treatment and management of adenomyosis[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 123-129.
[3] SHEN Hong,JI Feng. Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 643-650.
[4] YIN Xiaoliang,LANG Dehai,WANG Di. Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 588-594.
[5] YU Zuanbiao,LIN Zuodong,LANG Dehai. Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 623-627.
[6] LIN Zuodong,LANG Dehai. Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 595-600.
[7] WANG Xiaohui,HE Yangyan,WU Ziheng,ZHANG Hongkun. Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 577-582.
[8] DENG Xuan,HE Hanqing,ZHOU Yang,PAN Jinren,YAN Rui,TANG Xuewen,FU Jian. Economic evaluation of different chickenpox vaccination strategies[J]. J Zhejiang Univ (Med Sci), 2018, 47(4): 374-380.
[9] XU Weize,YE Jingjing,LI Jianhua,ZHANG Zewei,YU Jiangen,SHI Zhuo,YU Jin,SHU Qiang. Efficacy of percutaneous atrial septal defect closure guided by transesophageal echocardiography in children[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 244-249.
[10] ZHANG Yuxi,MO Xuming,SUN Jian,PENG Wei,QI Jirong,WU Kaihong,SU Yaqin. Application of thoracoscopic surgery in repairing esophageal atresia type Ⅲ with tracheoesophageal fistula in neonates[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 266-271.
[11] LYU Chengjie,HU Donglai,HUANG Shoujiang,QIN Qi,ZHAO Xiaoxia,HU Shuqi,ZHANG Yanan,FANG Xuan,GUO Xiaodong,TOU Jinfa. Transumbilical single-site laparoscopic surgery for congenital duodenal obstruction in neonates[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 261-265.
[12] ZHANG Shisong,WU Yurui,LIU Hongzhen,ZHAI Yunpeng,LIU Wei. Experience in treatment of complex congenital intestinal atresia in children[J]. J Zhejiang Univ (Med Sci), 2018, 47(3): 255-260.
[13] ZHU Ziyi,LI Zhijun,HE Zhengfu,WANG Yunzhen. Endoscopic trans-fistula drainage for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 637-642.
[14] LU Wei,LIN Mengna,ZHAO Shifang,WANG Huiming,HE Fuming. Application of modified lateral window for maxillary sinus floor augmentation[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 630-636.
[15] ZHANG Siying, CHEN Feng. Research progress of CT/MRI parametric response map in precision evaluation of therapeutic response of cancer patients[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 468-472.