Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study
Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study
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DOI：
10.1016/s0015-0282(03)00608-3
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发表时间：
2003-08-01
影响因子：
6.7
通讯作者：
Crosignani, PG
中科院分区：
文献类型：
--
作者：
Vercellini, P;Frontino, G;Crosignani, PG
目的：探讨症状性子宫内膜异位症患者术后放置左旋诺孕酮宫内节育器(LNG-IUD)与单纯手术治疗相比，痛经发生率和痛经严重程度是否有所降低。设计：开放、平行、随机、对照试验。地点：子宫内膜异位症患者三级护理和转诊中心。患者(S)：对中、重度痛经患者行一线手术腹腔镜治疗。干预(S)：子宫内膜异位症术后立即放置LNG-IUD或期待治疗。主要观察指标(S)：两组患者术后1年中重度痛经复发的比例和对治疗的总体满意度。结果(S)：术后LNG-IUD组中重度痛经复发2例(10%)，单纯手术组9/20例(45%)。因此，手术后插入的药物装置将防止三分之一的患者在手术后一年内再次出现中度或重度痛经。LNG-IUD组和期待管理组分别有15/20(75%)和10/20(50%)的妇女对所接受的治疗满意或非常满意。结论(S)：症状性子宫内膜异位症腹腔镜手术后放置LNG-IUD显著降低了中重度痛经中期复发的风险。(C)2003年，由美国生殖医学学会提供。
Objective: To determine whether the frequency and severity of dysmenorrhea are reduced in women with symptomatic endometriosis in whom a levonorgestrel-releasing intrauterine device (Lng-IUD) is inserted after operative laparoscopy compared with those treated with surgery only.Design: Open-label, parallel-group, randomized, controlled trial.Setting: A tertiary care and referral center for patients with endometriosis.Patient(s): Parous women with moderate or severe dysmenorrhea undergoing first-line operative laparoscopy for symptomatic endometriosis. Intervention(s): Randomization to immediate Lng-IUD insertion or expectant management after laparoscopic treatment of endometriotic lesions.Main Outcome Measure(s): Proportions of women with recurrence of moderate or severe dysmenorrhea in the two study groups 1 year after surgery and overall degree of satisfaction with treatment.Result(s): Moderate or severe dysmenorrhea recurred in 2 of 20 (10%) subjects in the postoperative Lng-IUD group and 9/20 (45%) in the surgery-only group. Thus, a medicated device inserted postoperatively will prevent the recurrence of moderate or severe dysmenorrhea in one out of three patients 1 year after surgery. A total of 15/20 (75%) women in the Lng-IUD group and 10/20 (50%) in the expectant management group were satisfied or very satisfied with the treatment received.Conclusion(s): Insertion of an Lng-IUD after laparoscopic surgery for symptomatic endometriosis significantly reduced the medium-term risk of recurrence of moderate or severe dysmenorrhea. (C) 2003 by American Society for Reproductive Medicine.